Reaping the Wisdom of Positive Deviants to Increase the Reach of Family Involvement in PTSD Treatment

点击翻译按钮获取中文摘要

BACKGROUND: Post-traumatic stress disorder (PTSD) is a devastating illness that has substantial costs to Veterans, their families, and the Veterans Health Administration (VA). Although effective treatments for PTSD exist, high rates of treatment dropout and generally sub-optimal response rates remain common. Incorporating family members in treatment represents one avenue for improving outcomes and providing Veteran-centered care, and surveys of Veterans in outpatient VA PTSD care indicate that 80% are interested in family involvement. However, despite this strong interest and potential for benefit, national administrative data show that <1% of Veterans in VA PTSD treatment have even a single family-involved session. To understand the factors contributing to the use of family involvement in PTSD treatment, the project team proposes a study using qualitative methods to assess relevant contextual factors. SIGNIFICANCE/IMPACT: The project is highly responsive to HSR&D’s Research Priorities, particularly the Whole Health approach to care which emphasizes the salience of Veterans’ broader context as a cornerstone of health and wellness. The project also has the potential to advance PTSD treatment for Veterans by distilling wisdom from facilities that have had relatively greater success in implementing family-inclusive care. Given the substantial disease burden of PTSD among VA patients, enhancing our treatment of this disorder would meaningfully improve the lives of millions of Veterans. INNOVATION: Despite research documenting the important bidirectional impacts between PTSD symptoms and social support, and the ways that family functioning and behaviors can impact PTSD treatment (in both positive and negative directions), to our knowledge there has been no systematic research to understand how family involvement is implemented in practice in VA. SPECIFIC AIMS: (1) To identify current practices, attitudes, and facilitators and barriers to family involvement through key stakeholder interviews (total n ≥ 30) at 5 “positive deviant” and 5 “lower-involvement” VA facilities. (2) To identify best clinical practices and recommendations for enhancing the implementation of family involvement through input from a Stakeholder Advisory Board. METHODOLOGY: The project is guided by the i-PARIHS framework. A Stakeholder Advisory Board (SAB) composed of operational partners, Veterans and family members, and other individuals with key knowledge will provide guidance and feedback throughout all phases of the project. Regarding methods, interviews will be conducted with clinicians and administrators at “positive deviant” VA facilities (those in the 90th percentile nationally with respect to incorporating family members into Veterans’ PTSD treatment), as well as at “lower- involvement” facilities (those in the 10th percentile). The premise of the positive deviant approach is that some members of a community have already discovered innovative solutions to problems which face that community, and these strategies or changes may be applied to improve the performance of others. Interview transcripts will be coded using a rapid analytic approach, allowing for efficient data reduction and identification of key themes. Results will then be transformed into matrices to allow for comparisons across facilities. Following the identification of factors that promote or inhibit the implementation of family involvement, tailored strategies will be selected that are likely to address each context-specific variable. IMPLEMENTATION: Recommendations for clinical/administrative best practices with regard to enhancing family involvement in PTSD treatment will be compiled into a provider-facing tip sheet, to be distributed by our operational partners as well as through the National Center for PTSD website. Findings will lead directly to a subsequent IIR proposal in which we will test the use of the identified implementation strategies to increase the uptake of family involvement in PTSD treatment, ultimately enhancing recovery from PTSD for Veterans.