Changes in Implementation of Two Evidence-Based Psychotherapies for PTSD in VA Residential Treatment Programs: A National Investigation
Changes in Implementation of Two Evidence-Based Psychotherapies for PTSD in VA Residential Treatment Programs: A National Investigation
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DOI：
10.1002/jts.21902
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发表时间：
2014-04-01
影响因子：
3.3
通讯作者：
Schnurr, Paula P.
中科院分区：
文献类型：
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作者：
Cook, Joan M.;Dinnen, Stephanie;Schnurr, Paula P.
在最初的执行工作结束后，随着时间的推移，几乎没有对循证治疗(EBTS)的自然过程进行调查。因此，我们对38个美国退伍军人事务部创伤后应激障碍(PTSD)住院治疗项目的提供者进行了定性访谈，以了解两种EBTS、长期暴露(PE)和认知加工疗法(CPT)在四年期间的两个时间点的实施和适应情况。随着时间的推移，接受治疗培训的提供者的数量和培训水平都有所提高。在基线情况下，在179个符合退伍军人培训要求的提供者中，65名(36.4%)接受了体育培训，111名(62.0%)接受了CPT培训，17名(9.5%)完成了案例咨询或成为体育和CPT的国家培训师。经跟进，在增加的190名合资格提供者中，87名(45.8%)曾接受体育方面的VA训练，135名(71.1%)接受CPT训练，其中69名(36.3%)及81名(42.6%)分别取得认证。22个项目(57.9%)报告在基线和随访期间PE使用没有变化，而16个项目(42.1%)报告增加。24个方案(63.2%)报告在基线和随访期间CPT的使用没有变化，12个方案(31.6%)方案增加，2个方案(5.2%)方案使用减少。相当多的供应商表示，他们对手册进行了修改(例如，裁剪、加长)。讨论了适应的原因。有人指出，有必要将时间和资源专门用于实施EBTS。
There has been little investigation of the natural course of evidence-based treatments (EBTs) over time following the draw-down of initial implementation efforts. Thus, we undertook qualitative interviews with the providers at 38 U.S. Department of Veterans Affairs' residential treatment programs for posttraumatic stress disorder (PTSD) to understand implementation and adaptation of 2 EBTs, prolonged exposure (PE), and cognitive processing therapy (CPT), at 2 time points over a 4-year period. The number of providers trained in the therapies and level of training improved over time. At baseline, of the 179 providers eligible per VA training requirements, 65 (36.4%) had received VA training in PE and 111 (62.0%) in CPT with 17 (9.5%) completing case consultation or becoming national trainers in both PE and CPT. By follow-up, of the increased number of 190 eligible providers, 87 (45.8%) had received VA training in PE and 135 (71.1%) in CPT, with 69 (36.3%) and 81 (42.6%) achieving certification, respectively. Twenty-two programs (57.9%) reported no change in PE use between baseline and follow-up, whereas 16 (42.1%) reported an increase. Twenty-four (63.2%) programs reported no change in their use of CPT between baseline and follow-up, 12 (31.6%) programs experienced an increase, and 2 (5.2%) programs experienced a decrease in use. A significant number of providers indicated that they made modifications to the manuals (e.g., tailoring, lengthening). Reasons for adaptations are discussed. The need to dedicate time and resources toward the implementation of EBTs is noted.