Dissemination of evidence‐based mental health interventions: Importance to the trauma field

Katon, Wayne; Zatzick, Doug; Bond, Gary R.; Williams, John W

doi:10.1002/jts.20147

Cited by 29 publications

(18 citation statements)

References 49 publications

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“…The VA’s implementation of CPT and PE represents one of the largest system change initiatives yet attempted within a nationwide health care system (Eftekhari et al, 2013) and provides a valuable case study to inform the growing literature on the dissemination and implementation of evidence-based practices (EBPs) in mental health settings (Chorpita & Regan, 2009; Katon, Zatzick, Bond, & Williams, 2006). Publications to date have documented specific dissemination and implementation strategies used by the VA in this effort, including: offering widespread provider training followed by a rigorous protocol for supervision; post-supervision consultation support; creation of a system of EBP coordinators at every VA medical center to serve as local champions; and development of performance measures and metrics to track implementation (Chard, Ricksecker, Healy, Karlin, & Resick, 2012; Karlin et al, 2010).…”

mentioning

confidence: 99%

Utilization of evidence-based psychotherapies in Veterans Affairs posttraumatic stress disorder outpatient clinics.

Finley

Garcia

Ketchum

et al. 2015

Psychological Services

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In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) and to identify individual and organizational factors associated with treatment uptake and adherence. Participants (N = 128) completed an electronic survey assessing reported utilization of PE and CPT treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment. Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of PE and CPT were significantly associated with utilization of and adherence to those treatments. Reported number of hours conducting supportive care was positively associated with feeling the clinic was not sufficiently staffed (p = .05). Adherence to the PE treatment manual was positively associated with receiving emotional support from co-workers (p<.01). Provider attitudes and organizational factors such as staffing and work relationships may have an important impact on treatment selection and the quality of PTSD care provided in VA PCTs.

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mentioning

confidence: 99%

Utilization of evidence-based psychotherapies in Veterans Affairs posttraumatic stress disorder outpatient clinics.

Finley

Garcia

Ketchum

et al. 2015

Psychological Services

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“…Despite these advances many individuals either go untreated or do not receive guideline-concordant PTSD care (Katon, Zatzick, Bond, & Williams, 2006).…”

Section: Example 4 How Population-based Sampling Can Enhance the Extmentioning

confidence: 99%

An epidemiologic approach to the development of early trauma focused intervention

Zatzick

Galea

2007

Journal of Traumatic Stress

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Early, trauma-focused intervention development has emphasized unidirectional trajectories that begin with basic research and efficacy trials followed later by effectiveness and dissemination studies. In this article, the authors present methods derived from social and clinical epidemiology that constitute foundational research in the development of early trauma-focused intervention. They also describe how population-based practice research may serve to feed back and inform what has been conceptualized as earlier stages of intervention development such as efficacy trials. Examples of relevant epidemiologic research methods are presented to illustrate these points. The authors posit that the continued application of population-based methods may produce treatments that can be feasibly applied to the unique patient, provider, organizational, and community contexts relevant to early interventions for survivors of trauma.

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“…45, 46 Collaborative care models have been identified as one of the most effective approach to improving quality of depression care and outcomes; 47 however, the diffusion of this model has remained limited partially as a result of the limited funding for costs related to these models. 48 Finally, the minimal rise in antidepressant spending could correspond to longer periods of treatment with antidepressants as has been shown in other research; 49 however, this change would not be reflected in either the quality measures examining acute episodes of depression or simple rates of utilization.…”

Section: Resultsmentioning

confidence: 90%

Ten-Year Trends in Quality of Care and Spending for Depression

Fullerton

Busch²,

Normand³

et al. 2011

Arch Gen Psychiatry

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Context Over the past decade, the introduction of generic versions of newer antidepressants and the release of FDA-warnings regarding suicidality in children, adolescents, and young adults may have had an impact on cost and quality of depression treatment. Objectives To examine longitudinal trends in service use, spending, and treatment quality for depression. Design Observational, trend study. Setting Florida, Medicaid enrollees from July 1996 to June 2006. Subjects Annual cohorts aged 18-64 diagnosed with depression. Main Outcome Measures Mental-health spending adjusted for inflation and case mix and components of mental-health spending, including inpatient, outpatient, and medication expenditures. Quality measures included measures of medication adherence, psychotherapy, and follow-up visits. Results Mental-health spending increased from an average of $2802 per enrollee to $3610 over this time period (29% increase). This increase occurred despite a mean decrease in inpatient spending (from $641 per enrollee to $373) and was driven primarily by an increase in pharmaceutical spending (up 110%) the bulk of which was due to spending on antipsychotics (up 949%). The percentage of enrollees with depression who were hospitalized decreased from 57% to 37% and the percentage using psychotherapy decreased from 9% to 5%. Antidepressant use increased from 82% to 87%, anxiety medication use was unchanged at 64%, and antipsychotic use increased from 27% to 42%. Changes in treatment quality were mixed, with measures of antidepressant use improving slightly, measures examining follow-up visits decreasing, and measures of psychotherapy utilization fluctuating. Conclusions Over a ten-year period, we found a substantial increase in spending for enrollees with depression associated with minimal improvements in quality of care. Antipsychotic use contributed significantly to the increase in spending while contributing little to traditional measures of quality.

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Dissemination of evidence‐based mental health interventions: Importance to the trauma field

Cited by 29 publications

References 49 publications

Utilization of evidence-based psychotherapies in Veterans Affairs posttraumatic stress disorder outpatient clinics.

Utilization of evidence-based psychotherapies in Veterans Affairs posttraumatic stress disorder outpatient clinics.

An epidemiologic approach to the development of early trauma focused intervention

Ten-Year Trends in Quality of Care and Spending for Depression

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