Theory-Driven Mixed-Methods Evaluation of PTSD Treatment Implementation in VA Res

描述（由申请人提供）：该申请涉及广泛的挑战领域（15）转化科学和特定的挑战主题（15- mh -105）支持临床社区和环境中干预措施吸收的策略。在精神卫生服务机构中实施循证治疗是改善服务质量和患者预后的主要优先事项。由于从伊拉克和阿富汗战争归来的100多万士兵以及最近意外涌入的越南退伍军人进入治疗，迫切需要研究促进退伍军人创伤后应激障碍治疗提供者循证实践的策略。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。本研究旨在评估退伍军人事务部（VA）创伤后应激障碍（PTSD）住院治疗项目（N= 40）中两项全国性的循证治疗方案，该方案采用理论驱动、经验为基础、多层次的传播和实施框架。总体目标是描述和评估PTSD的两种循证心理疗法，延长暴露（PE）和认知加工疗法（CPT）的实施过程。调查将测量可能影响实施的环境因素，特别强调临床医生对治疗的感知特征、环境支持、社会网络和同行意见领袖。拟议的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（NC-PTSD）合作进行，东北项目评估项目（NEPEC）监督全国所有VA心理健康项目，国家创伤后应激障碍中心（NC-PTSD）监督PE和CPT在VA提供者中的传播。我们计划通过在线自我调查问卷、半结构化访谈和现场观察，对250多名住院PTSD治疗机构的心理健康提供者进行定量和定性评估，以扩大NC-PTSD的传播项目评估工作。实施结果将包括项目和个别提供者完全、部分和修改后的采用，以及患者的结果。利用现有的NEPEC患者结局监测，PE和CPT的实施效果可以从退伍军人的PTSD症状、药物滥用、暴力行为、就业和治疗满意度等方面进行检查。本应用程序旨在通过理论驱动、经验为基础、多层次的传播和实施框架，检验退伍军人事务部（VA）创伤后应激障碍（PTSD）住院治疗项目（N= 40）中两种基于证据的心理疗法——延长暴露疗法和认知加工疗法的推出情况。退伍军人事务部是美国最大的医疗保健组织。研究VA实践中PE和CPT实施的过程和结果是一项迫切的公共卫生需求，并且可能有潜力推进有效实施策略的知识，以改善其他联邦资助的精神卫生系统对循证治疗的吸收。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (15) Translational Science and specific Challenge Topic (15-MH-105) Strategies to Support Uptake of Interventions within Clinical Community and Settings. Implementation of evidence-based treatments into mental health service settings is a major priority for improving the quality of services and outcomes for patients. Studies of strategies to promote evidence-based practices among VA PTSD treatment providers are an urgent necessity due to influx of over a million soldiers returning from wars in Iraq and Afghanistan and a recent unexpected flood of Vietnam Veterans entering treatment. If inadequately treated, PTSD can become a chronic disorder contributing to substantial psychological and physical impairments, as well as social and occupational disabilities. This application proposes to evaluate two national roll- outs of evidence-based treatments in Department of Veterans Affairs (VA) residential Posttraumatic Stress Disorder (PTSD) treatment programs (N= 40) within a theory-driven, empirically-based, multi-level dissemination and implementation framework. The overarching goal is to characterize and assess the implementation process of the two evidenced-based psychotherapies for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). The investigation will measure contextual factors likely to impact implementation, with particular emphasis placed on clinicians' perceived characteristics of the therapies, environmental support, social networks and peer opinion leaders. 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 (NC-PTSD), which oversees the dissemination of PE and CPT nationally among VA providers. We plan to extend the dissemination program evaluation efforts of the NC-PTSD by adding quantitative and qualitative assessments of over 250 mental health providers in residential PTSD treatment settings through online self-administered questionnaires, semi-structured interviews and on-site observation. Implementation outcomes will include full, partial and modified adoption by programs and individual providers, as well as patient outcomes. Capitalizing on existing NEPEC patient outcome monitoring, the effect of implementation of PE and CPT can be examined in terms of Veterans' PTSD symptoms, substance abuse, violent behavior, employment and satisfaction with treatment. This application proposes to examine roll-outs of two evidence-based psychotherapies, Prolonged Exposure and Cognitive Processing Therapy, in Department of Veterans Affairs (VA) residential Posttraumatic Stress Disorder (PTSD) treatment programs (N= 40) within a theory-driven, empirically-based, multi-level dissemination and implementation framework. The VA is the nation's largest health care organization. Studying the process and outcome of PE and CPT implementation in VA practice is an urgent public health necessity and likely has the potential to advance knowledge about effective implementation strategies for improving the uptake of evidence-based treatments in other federally-funded mental health systems.