Increasing Reach of Evidence-Based Psychotherapies in CBOCs: Identifying Needs and Strategies for Scale Out

循证心理疗法（EBP）已被证明对许多现有问题的有效性 包括创伤后应激障碍抑郁和焦虑这些疾病的发病率在以下国家升高： 退伍军人，造成重大的公共卫生影响。未经治疗的心理健康诊断会增加 自杀，进一步提高了对有效治疗的需求。努力治疗这些心理健康问题， 退伍军人事务部（VA）的问题在很大程度上是通过国家EBP的推出来解决的。这些 EBP的推出已得到广泛传播，但在VA环境中的应用有限， 特别是在社区门诊诊所（CBOC）。通过社区组织委员会获得电子商务方案至关重要， 提高精神卫生保健的及时性和效率，因为超过一半的退伍军人使用VA系统 去CBOC接受治疗此外，向农村社区组织提出的退伍军人接受的心理治疗明显减少， 与城市社区组织中心相比，保健预约情况突出显示了不同地点在获得保健方面的差异。 虽然我们知道，农村退伍军人得到较少的照顾，大多数关于EBP实施的研究 都是在央行之外完成的确定CBOC中的退伍军人正在获得什么样的护理，为什么他们 可能无法获得EBP，如何满足CBOC提供商的需求对于提高EBP的可及性至关重要 通过量身定制的实施战略。如果没有这些信息， CBOC不太可能，获得精神保健的问题将永久存在。最大化 在CBOCs广泛实施EBP的可能性，实施战略必须可行 在CBOC环境中是可以接受的，其中包括对农村和城市环境的考虑。EBP VA系统中的实施传统上是自上而下的方法，这可能会忽略重要的 影响成功实施的背景因素。经常被忽视的重要因素包括， 可能需要调整干预措施，并提供最适合的护理环境。鉴于CBOC 与主要VA医院有显著差异，了解这些因素的影响很重要。重要 有关这些背景因素的信息可以通过与CBOC提供者的定性访谈获得 在农村和城市环境中。该项目将最大限度地利用一个独特的机会，了解潜在的适合 在社区组织中心提供电子商务方案的替代办法，以扩大电子商务方案的覆盖面和维持能力。研究将 以循证概念框架为指导，并将利用利益攸关方咨询委员会， 加强农村和城市社区组织实施战略的专家建议。研究性学习 将由一个具有实施科学、定性分析和 VA系统内的EBPs。在业务伙伴的投入下，所产生的产品有可能 显著提高农村和城市社区组织实施EBP的及时性和效率 设置.总的来说，拟议的研究将推动国家努力，最大限度地提供最佳的临床治疗。 在农村和城市环境中的社区组织中心的做法，并将最大限度地提高效率和及时性， 照顾退伍军人。该项目的下一步将是通过提交一份综合报告来传播调查结果， 允许测试临床建议和可定制的扩大战略，以增加获得， 在农村和城市社区组织中心使用循证保健方案。

Evidence-based psychotherapies (EBPs) have demonstrated effectiveness for numerous presenting problems including posttraumatic stress disorder, depression, and anxiety. Rates of these disorders are elevated in Veterans, creating a significant public health impact. Untreated mental health diagnoses increase risk of suicide, further elevating the need for effective treatments. Efforts to treat these mental health problems within the Department of Veterans Affairs (VA) have largely been addressed through national EBP rollouts. These EBP rollouts have been disseminated broadly, yet limited uptake has been demonstrated across VA settings, especially in Community Based Outpatient Clinics (CBOCs). Access to EBPs through CBOCs is crucial to increase timeliness and efficiency in mental healthcare as more than half of Veterans utilizing the VA system go to CBOCs for care. Moreover, Veterans presenting to rural CBOCs are receiving significantly less mental health appointments compared to urban CBOCs, highlighting a discrepancy in access to care by location. Although we know that rural Veterans are receiving less care, most of the research on EBP implementation has been done outside of the CBOC setting. Identifying what care Veterans in CBOCs are getting, why they may not be getting EBPs, and how to meet the needs of CBOC providers is vital to enhancing access to EBPs through tailored implementation strategies. Without this information, enhanced implementation of EBPs in CBOCs is unlikely and the access to mental health care problem will be perpetuated. To maximize the likelihood of broad EBP implementation in CBOCs, it is essential that implementation strategies are feasible and acceptable in CBOC contexts, which includes consideration for both rural and urban settings. EBP implementation in the VA system has traditionally been a top-down approach, which may ignore important contextual factors that impact successful implementation. Important factors that are often overlooked include, the potential need for adaptations to interventions and delivery to best fit context of care. Given that CBOCs differ significantly from main VA hospitals, understanding the impact of these factors is important. Important information about these contextual factors can be obtained through qualitative interview with CBOC providers in rural and urban settings. This project will maximize a unique opportunity to understand the potential fit of alternative approaches for EBP delivery in CBOCs to enhance reach and sustainment of EBPs. Research will be guided by evidence-based conceptual frameworks and will utilize a stakeholder advisory board to produce expert recommendations to enhance implementation strategies in rural and urban CBOCs. The research study will be conducted by a team of investigators with expertise in implementation science, qualitative analyses and EBPs within the VA systems. With input from operational partners, the resulting products have the potential to significantly improve timeliness and efficiency in EBP implementation in CBOCs across rural and urban settings. Over all, the proposed study will advance national efforts to maximize delivery of best clinical practices for CBOCs in rural and urban settings and will maximize efficiency and timeliness of mental health care for Veterans. Next steps for this project will be to disseminate findings through an IIR submission that will allow for testing of clinical recommendations and tailorable scale-up strategies for increasing access to, and use of, EBPs in rural and urban CBOCs.