This study highlighted research and clinical challenges in providing services to the newest veteran generation in general as well as unique challenges with VTC. One complicating factor to the statistical power of this study was a treatment dropout rate twice the original estimate. Factors that could have influenced this high dropout rate are explored.

The Veterans Health Administration (VHA) has continued to emphasize the availability, access, and utilization of high quality mental health care particularly in the treatment of posttraumatic stress disorder (PTSD). While dissemination and availability of evidence-based psychotherapies (EBPs) have only increased, treatment engagement and utilization have continued to be oft-noted challenges. Administrators, researchers, and individual clinicians have continued to develop and explore novel systemic and individualized interventions to address these issues. Pilot studies utilizing shared decision-making models to aid in veteran treatment selection have demonstrated the impact this approach may have on selection of and engagement in EBPs for PTSD. Based on these promising studies, a Department of Veterans Affairs (VA) outpatient PTSD clinic began to implement a shared-decision making intervention as part of a clinic redesign. In seeking to evaluate the impact of this intervention, archival clinical data from 1,056 veterans were reviewed by the authors for rates of treatment selection, EBP initiation, session attendance, and EBP completion. Time elapsed from consult until EBP initiation was also computed by the authors. These variables were then compared on the basis of whether the veteran received the shared-decision making intervention. Veterans who received the intervention were more likely to select and thus initiate an EBP for PTSD sooner than veterans who did not receive this intervention. Veterans, whether receiving the intervention or not, did not differ in therapy session attendance and completion. Implications of these findings and directions for future study are further discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The U.S. Department of Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guideline (CPG) for the Management of Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder strives to advance the VA's practice of recovery-oriented, evidence-based, patient-centered care (PCC) for veterans with PTSD. A core foundation of PCC is that care is individually tailored to meet the needs and preferences of each patient. Accordingly, the 2017 update to the CPG specifically recommends the use of shared decision making (SDM), an individualized collaborative approach to treatment planning, in the PTSD treatment planning process. Although SDM has been promoted by the CPG throughout the VA and SDM training is being developed, no systemic training was available at the time the guidelines were updated. Additionally, while early research has studied the impact and experience of SDM for the patient, no work has explored provider experiences with SDM for those who work with trauma populations. This project bridges this gap by examining survey data collected 6 months following a formal SDM training to staff and trainees working with veterans who have experienced trauma within a trauma clinic at a large VA hospital. After the training, clinicians understood SDM and were engaging in SDM with their patients. Patients indicated that they were satisfied with and felt like an active participant in the treatment planning process. Clinician assumptions about the SDM process and barriers to SDM shown in previous research were also demonstrated. Implications for future research and practice, such as using decision aids in PTSD treatment planning and targeting clinician beliefs about SDM, are discussed. Impact StatementRecent PTSD clinical practice guidelines recommend engaging patients in SDM, however, research on SDM for PTSD treatment planning is lacking. We found that provider-facing SDM training promotes understanding and use of SDM among PTSD care team members, and patients are satisfied with the incorporation of SDM into PTSD treatment planning. Further development of providerfacing SDM training for PTSD care, such as the virtual training VA recently rolled, is warranted.

The present study explored interest in treatment and treatment initiation patterns among veterans presenting at a VA posttraumatic stress disorder (PTSD) clinic. U.S. veterans who were referred for treatment of posttraumatic stress symptoms (N = 476) attended a 2-session psychoeducation and orientation class where they completed measures of demographic variables, PTSD and depression symptom severity, and interest in treatment. Consistent with previous literature and our hypotheses, Vietnam (OR = 1.78) and Persian Gulf veterans (OR = 2.05) were more likely than Iraq and Afghanistan veterans to initiate treatment. Veterans reporting more severe PTSD and depression symptoms were more likely to initiate treatment than not (OR for PTSD = 1.02, OR for depression = 1.02). Interest in treatment emerged as a strong predictor of treatment initiation. Specifically, interest in trauma-focused treatment showed a significant independent predictive effect on initiation such that veterans who expressed interest in trauma-focused treatment were significantly more likely to initiate treatment than those who did not express interest (OR = 2.13). Building interest in trauma-focused treatment may be a vital component for engaging veterans in evidence-based trauma-focused therapy.