Sustained Use of Evidence-Based PSTD Treatment in VA Residential Settings

描述（由申请人提供）：本申请响应NIMH PA-10-038，“健康领域的传播和实施研究”，提出了一项关于如何实现基于证据的心理治疗的持续使用的主要公共卫生优先事项的研究。它建立在现有的基础设施和RC1 MH088454的初步发现的基础上，RC1 MH088454调查了创伤后应激障碍（PTSD）的两种基于证据的治疗方法（延长暴露- PE和认知处理疗法- CPT）的初步采用，这两种治疗方法在退伍军人事务部（VA）的住宅治疗环境中史无前例地推出。由于从伊拉克和阿富汗战争中返回的100多万士兵以及最近意外涌入的越南退伍军人进入治疗，迫切需要了解影响VA创伤后应激障碍治疗提供者持续使用循证实践的因素。如果治疗不当，创伤后应激障碍可能成为一种慢性疾病，造成严重的心理和身体损伤，以及社会和职业残疾。利用理论驱动的、基于经验的、多层次的框架，本应用程序建议对在RC1中研究的退伍军人创伤后应激障碍住院治疗设置的临床医生进行数年的跟踪，以确定他们持续使用PE和CPT的程度和形式。调查评估了预计会影响持续使用的组织和临床医生因素，特别强调临床医生对治疗方法、组织支持、社会网络和同行意见领袖的看法。拟议研究的另一个创新之处是检查持续使用这两种循证治疗方法在多大程度上改善了患者的治疗效果，退伍军人的创伤后应激障碍症状、药物滥用、暴力行为和就业也将被检查。该研究将与东北项目评估项目（NEPEC）和国家创伤后应激障碍中心合作进行，NEPEC负责监督VA全国范围内所有的心理健康项目，而国家创伤后应激障碍中心负责监督VA全国范围内PE和CPT的传播。对住院PTSD治疗环境中的心理治疗提供者的定量和定性评估将包括在线自我管理问卷，半结构化访谈和结构化反思日志。PE和CPT保真度的测量包括临床医生自我报告、临床医生从去识别的国家数据库中遇到的进展记录，以及与标准化患者的互动。实施结果将被概念化，包括项目和个体提供者的全面、部分和修改的持续使用，以及患者的精神病学结果。

DESCRIPTION (provided by applicant): This application responds to NIMH PA-10-038, "Dissemination and Implementation Research in Health" with a proposed study examining the major public health priority of how to achieve sustained use of evidence- based psychotherapies. It builds on the existing infrastructure and preliminary findings from a RC1 MH088454 that investigated the initial adoption of two evidence-based treatments (Prolonged Exposure - PE and Cognitive Processing Therapy - CPT) for Posttraumatic Stress Disorder (PTSD) in an unprecedented roll out occurring in the Department of Veterans Affairs (VA) residential treatment settings. An understanding of factors influencing sustained use of evidence-based practices among VA PTSD treatment providers are urgently needed due to an influx of over a million soldiers returning from wars in Iraq and Afghanistan and a recent unexpected flood of Vietnam Veterans entering treatment. When inadequately treated, PTSD can become a chronic disorder contributing to substantial psychological and physical impairments, as well as social and occupational disabilities. Utilizing a theory-driven, empirically-based, multi-level framework, this application proposes to follow for several years clinicians from the VA residential PTSD treatment settings who were studied in the RC1 to determine the extent to which their use of PE and CPT have been sustained and in what form. The investigation assesses organizational and clinician factors expected to influence sustained use, with particular emphasis placed on clinicians' perceptions of the therapies, organizational support, social networks and peer opinion leaders. Another innovative feature of the proposed research is an examination of the extent to which sustained use of these two evidence-based treatments translates into improved patient outcomes, veterans' PTSD symptoms, substance abuse, violent behavior, and employment will also be examined. The proposed study will be conducted in partnership with the Northeast Program Evaluation Program (NEPEC), which monitors all VA mental health programming nationwide, and the National Center for PTSD, which oversees the dissemination of PE and CPT nationally in VA. Quantitative and qualitative assessments of psychotherapy providers in residential PTSD treatment settings will include online self-administered questionnaires, semi-structured interviews and structured reflective journaling. Measures of PE and CPT fidelity include clinician self-report, clinician encounter progress notes from de-identified national database, and interaction with standardized patients. Implementation outcomes will be conceptualized in terms full, partial, and modified sustained use by programs and individual providers, as well as patient psychiatric outcomes.