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）转化科学和特定的挑战主题（15-MH-105）策略，以支持临床社区和环境中的干预措施。在精神卫生服务环境中实施循证治疗是改善服务质量和患者结局的主要优先事项。研究战略，以促进VA创伤后应激障碍治疗提供者之间的循证实践是一个紧迫的必要性，由于涌入超过一百万士兵从伊拉克和阿富汗战争返回，以及最近的越南退伍军人进入治疗意想不到的洪水。如果治疗不当，创伤后应激障碍可能成为一种慢性疾病，导致严重的心理和身体损伤，以及社会和职业残疾。本申请旨在评估两个国家在退伍军人事务部（VA）住院创伤后应激障碍（PTSD）治疗计划（N= 40）中推出的循证治疗，该计划是在理论驱动的、基于实践的、多层次的传播和实施框架内进行的。总体目标是表征和评估PTSD的两种循证心理疗法的实施过程，延长暴露（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的感知特征、环境支持、社交网络和同行意见领袖。拟议的研究将与东北计划评估计划（NEPEC）合作进行，该计划监测全国所有VA心理健康计划，以及国家创伤后应激障碍中心（NC-PTSD），该中心负责监督全国VA提供者之间的PE和CPT传播。我们计划通过在线自填问卷、半结构化访谈和现场观察，对250多名家庭创伤后应激障碍治疗机构的心理健康提供者进行定量和定性评估，从而扩大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、部分和修改后的采用，以及患者的结果。利用现有的NEPEC患者结果监测，PE和CPT的实施效果可以在退伍军人的PTSD症状，药物滥用，暴力行为，就业和治疗满意度方面进行检查。本申请旨在研究两种循证心理疗法（延长暴露和认知加工疗法）在退伍军人事务部（VA）住宅创伤后应激障碍（PTSD）治疗计划（N= 40）中的推广情况，该计划是在一个理论驱动的、基于实践的、多层次的传播和实施框架内进行的。VA是全国最大的医疗保健组织。研究的过程和结果的PE和CPT实施VA的做法是一个紧迫的公共卫生的必要性，并可能有可能推进知识的有效实施策略，以提高在其他联邦资助的精神卫生系统的循证治疗的吸收。

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.