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”，提出一项研究，审查如何实现持续使用循证心理治疗的主要公共卫生优先事项。它建立在现有基础设施和 RC1 MH088454 的初步调查结果的基础上，该调查调查了退伍军人事务部 (VA) 住宅治疗机构史无前例地推出的两种治疗创伤后应激障碍 (PTSD) 的循证疗法（长期暴露 - PE 和认知处理疗法 - CPT）的情况。由于超过 100 万士兵从伊拉克和阿富汗战争返回，以及最近大量越南退伍军人接受治疗，迫切需要了解影响 VA PTSD 治疗提供者持续使用循证实践的因素。如果治疗不充分，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损伤，以及社交和职业障碍。该应用程序利用理论驱动、基于经验的多层次框架，建议对 RC1 中研究的 VA 住院 PTSD 治疗机构的临床医生进行数年跟踪，以确定他们持续使用 PE 和 CPT 的程度以及以何种形式。该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的看法、组织支持、社交网络和同行意见领袖。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在多大程度上可以改善患者的治疗结果，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受到检查。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（该中心负责监督全国退伍军人事务部 PE 和 CPT 的传播）合作进行。东北计划评估计划负责监测全国所有退伍军人事务部心理健康计划。对住院 PTSD 治疗环境中心理治疗提供者的定量和定性评估将包括在线自填问卷、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、临床医生来自去识别化国家数据库的进展记录以及与标准化患者的互动。实施结果将通过项目和个人提供者的完全、部分和修改的持续使用以及患者的精神结果来概念化。

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.