Accelerating Implementation of Evidence-Based Psychotherapies in Military Settings

Feb 13, 2019

Although the U.S. military population experiences a high incidence of posttraumatic stress disorder (PTSD), evidence-based psychotherapies for PTSD remain difficult for service members to access.

The therapy for PTSD with the most scientific evidence supporting its use is Prolonged Exposure (PE), but numerous barriers often impair successful implementation of PE within the Military Health System (MHS). These barriers are complex and exist at multiple organizational levels, including at the provider level and within policies and guidelines of the MHS. Barriers to implementation of PE also may vary from one military treatment facility to another.

Investigators Craig Rosen, PhD, and Carmen McLean, PhD, with the Department of Veterans Affairs’ National Center for PTSD in Palo Alto, CA, and the Stanford University School of Medicine, are leading a STRONG STAR-affiliated study to address these barriers at eight military treatment facilities around the United States. The study team has developed a flexible implementation strategy, called Targeted Assessment and Context-Tailored Implementation of Change Strategies, or TACTICS, that is designed to improve the implementation of PE. In this research project, they will test the impact of TACTICS on the rate of PE use and patients’ PTSD treatment outcomes over and above standard provider training in PE.

At the individual military clinics participating in this study, the research team will work with clinical leadership and personnel to develop a tailored implementation plan for their unique clinic conditions. The TACTICS team will look at overall provider use of PE and patient treatment outcomes and will provide tools to boost implementation and performance.

The investigators hypothesize that accelerating the use of PE for PTSD within the MHS will increase the number of service members who can access and benefit from an effective treatment, enabling them to maintain or resume happy, productive lives in military careers, or as civilians. And as more patients recover, behavioral health clinics will have capacity to care for additional service members.

If TACTICS is effective in identifying solutions for the unique challenges of implementing PE, it could provide an intervention strategy for accelerating the use of other evidence-based treatments in military settings.