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Changes in Implementation of Two Evidence-Based Psychotherapies for PTSD in VA Residential Treatment Programs: A National Investigation

Authors

  • Joan M. Cook,

    Corresponding author
    1. Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA
    2. National Center for PTSD, Evaluation Division, West Haven, Connecticut, USA and Executive Division, White River Junction, Vermont, USA
    • Correspondence concerning this article should be addressed to Joan M. Cook, Yale School of Medicine, NEPEC/182, 950 Campbell Avenue, West Haven, Connecticut 06516. E-mail: Joan.Cook@yale.edu

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  • Stephanie Dinnen,

    1. Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA
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  • Richard Thompson,

    1. University of Illinois at Chicago, Department of Psychiatry, Chicago, Illinois, USA
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  • Vanessa Simiola,

    1. Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA
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  • Paula P. Schnurr

    1. National Center for PTSD, Evaluation Division, West Haven, Connecticut, USA and Executive Division, White River Junction, Vermont, USA
    2. Geisel School of Medicine at Dartmouth, Department of Psychiatry, Hanover, New Hampshire, USA
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  • This project described was supported by Award Number RC1-MH088454 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the U.S. Department of Veterans Affairs.

Abstract

There has been little investigation of the natural course of evidence-based treatments (EBTs) over time following the draw-down of initial implementation efforts. Thus, we undertook qualitative interviews with the providers at 38 U.S. Department of Veterans Affairs’ residential treatment programs for posttraumatic stress disorder (PTSD) to understand implementation and adaptation of 2 EBTs, prolonged exposure (PE), and cognitive processing therapy (CPT), at 2 time points over a 4-year period. The number of providers trained in the therapies and level of training improved over time. At baseline, of the 179 providers eligible per VA training requirements, 65 (36.4%) had received VA training in PE and 111 (62.0%) in CPT with 17 (9.5%) completing case consultation or becoming national trainers in both PE and CPT. By follow-up, of the increased number of 190 eligible providers, 87 (45.8%) had received VA training in PE and 135 (71.1%) in CPT, with 69 (36.3%) and 81 (42.6%) achieving certification, respectively. Twenty-two programs (57.9%) reported no change in PE use between baseline and follow-up, whereas 16 (42.1%) reported an increase. Twenty-four (63.2%) programs reported no change in their use of CPT between baseline and follow-up, 12 (31.6%) programs experienced an increase, and 2 (5.2%) programs experienced a decrease in use. A significant number of providers indicated that they made modifications to the manuals (e.g., tailoring, lengthening). Reasons for adaptations are discussed. The need to dedicate time and resources toward the implementation of EBTs is noted.

Traditional and Simplified Chinese Abstracts by AsianSTSS

標題:全國性偵查有關VA 住宿治療計劃方面兩個PTSD 實證為本心理治療實施的變更

撮要:很少有調查有關實證為本治療(EBTs)在初期實施縮編後的自然進程,所以我們對38美國退役軍人事務部門創傷後壓力症(PTSD)住宿治療計劃的提供者進行定性訪談,以瞭解兩種EBTs(即延續暴露(PE)和認知處理法(CPT))在4年期間的兩個時間點的實施及適應情況。底線上有179名符合VA訓練要求的服務提供者,其中65名(36.4%)接受VA對PE的培訓而111名(62.0%)則接受CPT培訓,共17名(9.5%)完成個案諮詢或是PE和CP的全國教練。跟進時已增至190名合適的服務提供者,其中87名(45.8%)接受PE培訓和135名(71.1%)接受CPT 培訓,分別為69名(36.3%)和81名(42.6%)達致認可資格。22個計劃(57.9%)在底線和跟進間沒有PE應用的改變,而16個(42.1%)則增加使用。

24個(63.2%)計劃在底線和跟進期間沒有改變CPT的應用,12個(31.6%)則增加使用而2個(5.2%)則減少應用。相當數量的服務提供者指出他們對手冊作出修改(如剪裁和延長),改動的理由在本文也有討論。EBTs 實施時我們要注意時間和資源方面的需要。

标题:全国性侦查有关VA 住宿治疗计划方面两个PTSD 实证为本心理治疗实施的变更

撮要:很少有调查有关实证为本治疗(EBTs)在初期实施缩编后的自然进程,所以我们对38美国退役军人事务部门创伤后压力症(PTSD)住宿治疗计划的提供者进行定性访谈,以了解两种EBTs(即延续暴露(PE)和认知处理法(CPT))在4年期间的两个时间点的实施及适应情况。底在线有179名符合VA训练要求的服务提供商,其中65名(36.4%)接受VA对PE的培训而111名(62.0%)则接受CPT培训,共17名(9.5%)完成个案咨询或是PE和CP的全国教练。跟进时已增至190名合适的服务提供商,其中87名(45.8%)接受PE培训和135名(71.1%)接受CPT 培训,分别为69名(36.3%)和81名(42.6%)达致认可资格。22个计划(57.9%)在底线和跟进间没有PE应用的改变,而16个(42.1%)则增加使用。

24个(63.2%)计划在底线和跟进期间没有改变CPT的应用,12个(31.6%)则增加使用而2个(5.2%)则减少应用。相当数量的服务提供商指出他们对手册作出修改(如剪裁和延长),改动的理由在本文也有讨论。EBTs 实施时我们要注意时间和资源方面的需要。

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