Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration

Nina A Sayer; Craig S Rosen; Nancy C Bernardy; Joan M Cook; Robert J Orazem; Kathleen M Chard; David C Mohr; Shannon M Kehle-Forbes; Afsoon Eftekhari; Jill Crowley; Josef I Ruzek; Brandy N Smith; Paula P Schnurr

doi:10.1007/s10488-017-0809-y

Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration

Adm Policy Ment Health. 2017 Nov;44(6):904-918. doi: 10.1007/s10488-017-0809-y.

Authors

Nina A Sayer^{1

2

3

4}, Craig S Rosen^{5

6}, Nancy C Bernardy^{7

8}, Joan M Cook^{9

10}, Robert J Orazem¹¹, Kathleen M Chard^{12

13}, David C Mohr^{14

15}, Shannon M Kehle-Forbes^{11

16}, Afsoon Eftekhari⁵, Jill Crowley⁵, Josef I Ruzek^{5

6

17}, Brandy N Smith⁵, Paula P Schnurr^{7

8}

Affiliations

¹ Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA. nina.sayer@va.gov.
² Department of Medicine, University of Minnesota, Minneapolis, MN, USA. nina.sayer@va.gov.
³ Departments of Psychiatry, University of Minnesota, Minneapolis, MN, USA. nina.sayer@va.gov.
⁴ Department of Psychology, University of Minnesota, Minneapolis, MN, USA. nina.sayer@va.gov.
⁵ Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁶ Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
⁷ Executive Division, National Center for PTSD, White River Junction, VT, USA.
⁸ Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
⁹ Evaluation Division, National Center for PTSD, VA Connecticut Health Care System, West Haven, CT, USA.
¹⁰ Yale School of Medicine, NEPEC/182, 950 Campbell Avenue, West Haven, CT, USA.
¹¹ Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA.
¹² Cincinnati Department of Veterans Affairs (VA) Medical Center, Cincinnati, OH, USA.
¹³ University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁴ Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
¹⁵ Boston University School of Public Health, Boston, MA, USA.
¹⁶ Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
¹⁷ Palo Alto University, Palo Alto, CA, USA.

Abstract

Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment. Strategies to improve reach of evidence-based psychotherapies should attend to organizational and team-level factors.

Keywords: Evidence-based practices; Implementation; Mental health services; Mixed methods; Organization; Posttraumatic stress disorder.

MeSH terms

Ambulatory Care Facilities / organization & administration*
Ambulatory Care Facilities / standards
Attitude of Health Personnel
Cognitive Behavioral Therapy / organization & administration*
Cognitive Behavioral Therapy / standards
Environment
Evidence-Based Medicine / organization & administration
Humans
Implosive Therapy / organization & administration*
Implosive Therapy / standards
Mental Health Services / organization & administration*
Mental Health Services / standards
Organizational Culture
Stress Disorders, Post-Traumatic / rehabilitation*
United States
United States Department of Veterans Affairs
Work Engagement