Predictors of Treatment Interest and Treatment Initiation in a VA Outpatient Trauma Services Program Providing Evidence‐Based Care

Abstract

The present study explored interest in treatment and treatment initiation patterns among veterans presenting at a VA posttraumatic stress disorder (PTSD) clinic. U.S. veterans who were referred for treatment of posttraumatic stress symptoms (N = 476) attended a 2-session psychoeducation and orientation class where they completed measures of demographic variables, PTSD and depression symptom severity, and interest in treatment. Consistent with previous literature and our hypotheses, Vietnam (OR = 1.78) and Persian Gulf veterans (OR = 2.05) were more likely than Iraq and Afghanistan veterans to initiate treatment. Veterans reporting more severe PTSD and depression symptoms were more likely to initiate treatment than not (OR for PTSD = 1.02, OR for depression = 1.02). Interest in treatment emerged as a strong predictor of treatment initiation. Specifically, interest in trauma-focused treatment showed a significant independent predictive effect on initiation such that veterans who expressed interest in trauma-focused treatment were significantly more likely to initiate treatment than those who did not express interest (OR = 2.13). Building interest in trauma-focused treatment may be a vital component for engaging veterans in evidence-based trauma-focused therapy.

Evaluation of a shared decision-making intervention on the utilization of evidence-based psychotherapy in a VA outpatient PTSD clinic.

“…While the reasons for treatment selection were not collected, it is reasonable to hypothesize that a personalized discussion of an individual’s treatment goals may lead to the selection of a treatment that best meets those goals. This is supported by previous findings that expressed veteran treatment interest correlated with greater treatment initiation (Lamp et al, 2014). It is hypothesized that the one-on-one decision-making process allowed additional opportunities for education regarding treatment options than may be available if a veteran self-selects a treatment following an introductory group.…”

“…Appropriately, recent research has focused on factors that promote mental health utilization, particularly access, engagement, and initiation of services. One strong predictor of treatment initiation for PTSD among veterans was found to be an expressed interest in trauma-focused treatment (Lamp, Maieritsch, Winer, Hessinger, & Klenk, 2014). Among a sample of veterans referred to a PTSD outpatient clinic ( N = 476), interest in one of seven available treatment options predicted initiation independently of demographic factors typically associated with utilization (i.e., service era, gender, race).…”

Perspectives on a Stage-Based Treatment for Posttraumatic Stress Disorder Among Dialectical Behavior Therapy Consumers in Public Mental Health Settings

“…The present findings combined with prior research suggest several potential consumerfocused implementation strategies that may improve consumer engagement in TF-EBPs and, by extension, increase the uptake and reach of these highly effective treatments. First, the present study indicated that providing consumers with psychoeducational information about the efficacy and mechanisms of these treatments is associated with positive expectancies and a preference for DBT + DBT PE, a finding consistent with prior research on TF-EBPs (e.g., Feeny et al, 2009;Kehle-Forbes et al, 2014;Lamp, Maieritch, Winer, Hessinger, & Klenk, 2014;Mott et al, 2014). In addition, the manner in which this information is provided may be important.…”

The Ending Self‐Stigma for Posttraumatic Stress Disorder (ESS‐P) Program: Results of a Pilot Randomized Trial

“…Although self‐stigma may be discussed within these contexts, psychoeducation and skill‐building to address self‐stigma are not a core feature or focus of these treatments. Moreover, many veterans with PTSD do not utilize trauma‐specialty care, and dropout rates among those who do access evidence‐based practices (EBPs) for PTSD are consistently high (Lamp et al., 2014; Seal et al. 2010).…”