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

描述(由申请人提供)：本申请回应NIMH PA-10-038，“健康传播和实施研究”，建议进行一项研究，审查如何实现持续使用循证心理疗法的主要公共卫生优先事项。它建立在现有基础设施和来自RC1MH088454的初步调查结果的基础上，该调查最初采用了两种循证治疗方法(长时间暴露-PE和认知加工治疗-CPT)来治疗创伤后应激障碍(PTSD)，这是退伍军人事务部(VA)住院治疗环境中史无前例的推出。由于从伊拉克和阿富汗战争返回的100多万士兵涌入，以及最近意外涌入的越南退伍军人接受治疗，迫切需要了解影响退伍军人创伤后应激障碍治疗提供者持续使用循证做法的因素。如果治疗不当，创伤后应激障碍可能会成为一种慢性疾病，导致严重的心理和身体障碍，以及社会和职业残疾。利用一个理论驱动的、基于经验的、多层次的框架，该应用程序建议对来自退伍军人事务部住院PTSD治疗环境的临床医生进行数年的跟踪调查，以确定他们对PE和CPT的持续使用程度和形式。这项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特征是检查持续使用这两种循证治疗方法在多大程度上转化为改善患者结果，还将检查退伍军人的创伤后应激障碍症状、药物滥用、暴力行为和就业情况。这项拟议的研究将与东北计划评估计划(NEPEC)和国家创伤后应激障碍中心(National Center For PTSD)合作进行，前者监测全国所有退伍军人精神卫生规划，后者监督退伍军人事务部在全国范围内传播体育和CPT。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记。PE和CPT保真度的衡量标准包括临床医生自我报告、临床医生遇到来自未识别的国家数据库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，包括由项目和个人提供者持续使用的全部、部分和修改的持续使用，以及患者的精神结果。

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.