Family Involvement in PTSD Treatment: Perspectives from a Nationwide Sample of Veterans Health Administration Clinicians

Abstract

Social support is bidirectionally linked to symptoms of posttraumatic stress disorder (PTSD). Evidence suggests that family involvement in veterans’ mental health treatment is desired by both veterans and family members, and that such involvement has the potential to improve treatment outcomes. However, rates of family involvement are low in the Veterans Health Administration (VHA). We sought to understand VHA clinicians’ perspectives on family involvement in PTSD treatment by conducting qualitative interviews with 31 providers at 10 VHA facilities across the U.S. The i-PARIHS framework was used to guide the interviews and analysis, and several major themes were identified. All clinicians reported that they at least occasionally offered family-inclusive sessions, and they frequently referenced both the influence of family behaviors or attitudes on veterans’ functioning, and also how veterans’ symptoms could cause tremendous disruption in the family. Clinicians’ past experience with supervised family- or couple-based work strongly influenced their current comfort with family-inclusive sessions. Multiple potential avenues exist to support increased family involvement in PTSD treatment in VHA.

Feasibility of a family-involved intervention to increase engagement in evidenced-based psychotherapies for posttraumatic stress disorder: A pilot study.

“…For example, providers discussed a positive attribute of FAMILIAR as the importance of aligning SP expectations of treatment with the reality of trauma-focused treatment, and several veterans/SP dyads reported that FAMILIAR helped the dyad to prepare for EBP sessions and know what to expect. These perspectives align with prior work showing that VA providers acknowledge that family involvement could enhance PTSD care, especially PE and CPT (Thompson-Hollands et al, 2022).…”

“…Therefore, implementing FAMILIAR and other family-involved interventions within VA and in other health systems will require system-level innovations in how to address reimbursement structures, documentation, flexible scheduling for employed SPs, and procedures to maintain veteran and SP confidentiality. Like prior studies, we identified concerns about limited staffing resources to offer family-involved interventions (Thompson-Hollands et al, 2022). Within mental health services, there may be a need to grow some providers’ skills in conjoint therapeutic approaches and knowledge of family-inclusive treatments (Thompson-Hollands et al, 2022).…”

“…Like prior studies, we identified concerns about limited staffing resources to offer family-involved interventions (Thompson-Hollands et al, 2022). Within mental health services, there may be a need to grow some providers’ skills in conjoint therapeutic approaches and knowledge of family-inclusive treatments (Thompson-Hollands et al, 2022). For FAMILIAR, in particular, the conjoint sessions and activities might require prior preparation for providers with limited dyadic experience and substantial encouragement from facility leadership.…”

Retention in Individual Trauma-Focused Treatment Following Family-Based Treatment Among US Veterans

“…22 Furthermore, prior work suggests that veterans have a preference for including their family in treatment for PTSD [23][24][25] and VHA clinicians also have positive views regarding the importance of family-level treatment adjunctive to individual treatment for PTSD. 26 Recent VHA data on the utilization of family therapy in mental health clinics…”

“…As of 2020, about half of all military personnel were married, and about a third had at least 1 child, indicating a majority of veterans may have a close family member who could be included in treatment . Furthermore, prior work suggests that veterans have a preference for including their family in treatment for PTSD and VHA clinicians also have positive views regarding the importance of family-level treatment adjunctive to individual treatment for PTSD . Recent VHA data on the utilization of family therapy in mental health clinics shows that VHA patients diagnosed with PTSD report receiving more of any type of family therapy compared with those diagnosed with other mental health conditions .…”