The influence of patient readiness on implementation of evidence-based PTSD treatments in Veterans Affairs residential programs.

Abstract

Objective Mental health provider perceptions of patient readiness for trauma-focused evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) have been found to impact outpatient care in the Department of Veterans Affairs (VA). Method One hundred and seventy two mental health directors and providers from 36 VA residential PTSD treatment programs completed qualitative interviews regarding implementation of two EBTs, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). Perceptions of patients’ “readiness” for PE and CPT, including how to define and assess this construct and how it influences implementation of these EBTs, were discussed. Results Patient readiness was identified as having three components: psychological and psychiatric stability, general readiness to change, and specific skills to manage trauma-focused EBTs (e.g., distress tolerance, affect regulation skills). Providers indicated that some patients who are deemed not ready are either screened out prior to entry or helped to get ready prior to or during their residential stay. Providers expressed difficulties predicting who is actually ready and described what they saw as differences between readiness for PE as compared to CPT. Conclusions The concept of readiness for trauma-focused EBTs impacted admission and access to services in the programs. Future research directions, such as empirically measuring readiness and formally assessing veterans’ perceptions of and willingness to participate in these EBTs, are considered.

Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

“…Readiness refers to an individual's level of psychological “preparedness” to undertake tasks associated with engaging in, and utilizing the provisions of psychological therapy (Ogrodniczuk, Joyce, & Piper, ). Factors contributing to readiness have been suggested to be a willingness to engage in treatment; an openness to revealing painful feelings and experiences; perseverance; coping skills; safety and stability (psychiatric and physical); and motivation for treatment (Cook, Simiola, Hamblen, Bernardy, & Schnurr, ; Ogrodniczuk et al, ).…”

“…Factors contributing to readiness have been suggested to be a willingness to engage in treatment; an openness to revealing painful feelings and experiences; perseverance; coping skills; safety and stability (psychiatric and physical); and motivation for treatment (Cook, Simiola, Hamblen, Bernardy, & Schnurr, 2017;Ogrodniczuk et al, 2009).…”

Trauma-Informed Telehealth in the COVID-19 Era and Beyond

“…18,19 Given the range of possible responses to the experience of trauma, not all veterans with trauma histories need to, chose to, or feel ready to access trauma-specific treatments. 20 In contrast, TIC is a global, universal precautions approach to providing quality care that can be applied to all aspects of health care and to all patients. 21 TIC is a strengths-based service delivery framework that is grounded in an understanding of, and responsiveness to, the disempowering impact of experiencing trauma.…”

Examination of Referral Source and Retention Among Women in Residential Substance Use Disorder Treatment: A Prospective Follow-Up Study

“…This reasoning is further supported in this study by pairwise group comparisons showing women mandated by the CJ system had signi cantly lower scores for mental health characteristics (PTSD, depression, stress, and anxiety) compared to those who were CPS mandated or nonmandated. This is critical because psychiatric stabilization is a key component in SUD treatment readiness and engagement [39] and also an eligibility component for entry into mandated residential SUD treatment [37].…”