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

描述(由申请人提供)：本申请涉及广泛的挑战领域(15)转化科学和特定挑战主题(15-MH-105)支持在临床社区和环境中采用干预措施的战略。在精神卫生服务环境中实施循证治疗是改善患者服务质量和结果的主要优先事项。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，迫切需要研究在退伍军人创伤后应激障碍治疗提供者中促进循证做法的战略。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。本申请建议在理论驱动、基于经验的多层次传播和实施框架内评估退伍军人事务部(VA)创伤后应激障碍(PTSD)治疗计划(N=40)中两个国家推出的循证治疗。总体目标是描述和评估两种针对创伤后应激障碍的循证心理疗法的实施过程，即长期暴露(PE)和认知加工疗法(CPT)。调查将衡量可能影响实施的背景因素，特别强调临床医生对治疗、环境支持、社会网络和同行意见领袖的感知特征。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(NC-PTSD)合作进行，东北计划评估计划(NEPEC)负责监测全国所有退伍军人精神健康规划，国家创伤后应激障碍中心(NC-PTSD)负责监督PE和CPT在全国退伍军人管理局提供者中的传播。我们计划通过在线自填式问卷、半结构访谈和现场观察，对住院创伤后应激障碍治疗环境中的250多名精神健康提供者进行定量和定性评估，从而扩展NC-PTSD的传播计划评估工作。实施结果将包括项目和个人提供者的全部、部分和修改采用情况，以及患者结果。利用现有的非住院患者结局监测，可以从退伍军人的创伤后应激障碍症状、药物滥用、暴力行为、就业和对治疗的满意度等方面来检验实施PE和CPT的效果。这项申请建议审查两种循证心理疗法的推出，延长暴露和认知处理疗法，在退伍军人事务部(VA)创伤后应激障碍(PTSD)住院治疗计划(N=40)中，在理论驱动、基于经验的多层次传播和实施框架内推出。退伍军人管理局是美国最大的医疗保健组织。研究在退伍军人管理局实践中实施PE和CPT的过程和结果是一项紧迫的公共卫生需求，并可能促进对有效实施战略的了解，以改善其他联邦资助的精神卫生系统采用循证治疗的情况。

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.