Skip to main content
Top
Published in: Administration and Policy in Mental Health and Mental Health Services Research 4/2015

01-07-2015 | Original Article

A Quantitative Test of an Implementation Framework in 38 VA Residential PTSD Programs

Authors: Joan M. Cook, Stephanie Dinnen, Richard Thompson, Josef Ruzek, James C. Coyne, Paula P. Schnurr

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 4/2015

Login to get access

Abstract

This study examines the implementation of two evidence-based psychotherapies, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), in the Department of Veterans Affairs residential Posttraumatic Stress Disorder treatment programs. Two hundred and one providers from 38 programs completed an online survey concerning implementation of PE delivered on an individual basis and CPT delivered in individual and group formats. For PE, a supportive organizational context (dedicated time and resources, and incentives and mandates) and overall positive view of the treatment were related to its implementation. For both group and individual CPT, only the supportive organizational context was significantly associated with outcome. Implications for implementation efforts are discussed.
Literature
go back to reference Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014). The implementation leadership scale (ILS): Development of a brief measure of unit level implementation leadership. Implementation Science, 9, 45.PubMedCentralPubMedCrossRef Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014). The implementation leadership scale (ILS): Development of a brief measure of unit level implementation leadership. Implementation Science, 9, 45.PubMedCentralPubMedCrossRef
go back to reference Aarons, G. A., & Sawitzky, A. C. (2006). Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological Services, 3, 61–72.PubMedCentralPubMedCrossRef Aarons, G. A., & Sawitzky, A. C. (2006). Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological Services, 3, 61–72.PubMedCentralPubMedCrossRef
go back to reference Becker, C. B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277–292.PubMedCrossRef Becker, C. B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277–292.PubMedCrossRef
go back to reference Bernardy, N. C., Hamblen, J. L., Friedman, M. J., Ruzek, J. I., & McFall, M. E. (2011). Implementation of a Posttraumatic Stress Disorder Mentoring Program to improve treatment services. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 292–299.CrossRef Bernardy, N. C., Hamblen, J. L., Friedman, M. J., Ruzek, J. I., & McFall, M. E. (2011). Implementation of a Posttraumatic Stress Disorder Mentoring Program to improve treatment services. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 292–299.CrossRef
go back to reference Borsboom, D., Mellenbergh, G. J., & Van Heerden, J. (2003). The theoretical status of latent variables. Psychological Review, 110, 203–219.PubMedCrossRef Borsboom, D., Mellenbergh, G. J., & Van Heerden, J. (2003). The theoretical status of latent variables. Psychological Review, 110, 203–219.PubMedCrossRef
go back to reference Cook, J. M., Biyanova, T., & Coyne, J. C. (2009a). Barriers to adoption of new treatments: An internet study of practicing community psychotherapists. Administration and Policy in Mental Health and Mental Health Services Research, 36, 83–90.PubMedCentralPubMedCrossRef Cook, J. M., Biyanova, T., & Coyne, J. C. (2009a). Barriers to adoption of new treatments: An internet study of practicing community psychotherapists. Administration and Policy in Mental Health and Mental Health Services Research, 36, 83–90.PubMedCentralPubMedCrossRef
go back to reference Cook, J. M., Dinnen, S., Coyne, J. C., Thompson, R., Simiola, V., Ruzek, J., et al. (2014). Evaluation of an Implementation Model: A National Investigation of VA Residential Programs. Administration and Policy in Mental Health and Mental Health Services Research. doi:10.1007/s10488-014-0555-3. Cook, J. M., Dinnen, S., Coyne, J. C., Thompson, R., Simiola, V., Ruzek, J., et al. (2014). Evaluation of an Implementation Model: A National Investigation of VA Residential Programs. Administration and Policy in Mental Health and Mental Health Services Research. doi:10.​1007/​s10488-014-0555-3.
go back to reference Cook, J. M., O’Donnell, C., Dinnen, S., Bernardy, N., Rosenheck, R., & Hoff, R. (2013). A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. Journal of Traumatic Stress, 26, 56–63.PubMedCentralPubMedCrossRef Cook, J. M., O’Donnell, C., Dinnen, S., Bernardy, N., Rosenheck, R., & Hoff, R. (2013). A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. Journal of Traumatic Stress, 26, 56–63.PubMedCentralPubMedCrossRef
go back to reference Cook, J. M., O’Donnell, C., Dinnen, S., Coyne, J. C., Ruzek, J. I., & Schnurr, P. (2012). Measurement of a model of implementation for health care: Toward a testable theory. Implementation Science, 7, 59–74.PubMedCentralPubMedCrossRef Cook, J. M., O’Donnell, C., Dinnen, S., Coyne, J. C., Ruzek, J. I., & Schnurr, P. (2012). Measurement of a model of implementation for health care: Toward a testable theory. Implementation Science, 7, 59–74.PubMedCentralPubMedCrossRef
go back to reference Cook, J. M., Schnurr, P. P., Biyanova, T., & Coyne, J. C. (2009b). Apples don’t fall far from the trees: Influences on psychotherapists’ adoption and sustained use of new therapies. Psychiatric Services, 60, 671–676.PubMedCentralPubMedCrossRef Cook, J. M., Schnurr, P. P., Biyanova, T., & Coyne, J. C. (2009b). Apples don’t fall far from the trees: Influences on psychotherapists’ adoption and sustained use of new therapies. Psychiatric Services, 60, 671–676.PubMedCentralPubMedCrossRef
go back to reference Department of Veterans Affairs. (2008). Uniform Mental Health Services in VA Medical Centers and Clinics (VHA Handbook 1160.01). Washington, DC: Department of Veterans Affairs. Department of Veterans Affairs. (2008). Uniform Mental Health Services in VA Medical Centers and Clinics (VHA Handbook 1160.01). Washington, DC: Department of Veterans Affairs.
go back to reference Diamantopoulos, A., & Siguaw, J. A. (2006). Formative versus reflective indicators in organizational measure development: A comparison and empirical illustration. British Journal of Management, 17, 263–282.CrossRef Diamantopoulos, A., & Siguaw, J. A. (2006). Formative versus reflective indicators in organizational measure development: A comparison and empirical illustration. British Journal of Management, 17, 263–282.CrossRef
go back to reference Dobson, K. S., & Singer, A. R. (2005). Definitional and practical issues in the assessment of treatment integrity. Clinical Psychology: Science and Practice, 12, 384–387. Dobson, K. S., & Singer, A. R. (2005). Definitional and practical issues in the assessment of treatment integrity. Clinical Psychology: Science and Practice, 12, 384–387.
go back to reference Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.PubMedCrossRef Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.PubMedCrossRef
go back to reference Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. R., Greenbaum, M. A., & Karlin, B. E. (2013). Effectiveness of national implementation of prolonged exposure therapy in VA care. JAMA Psychiatry, 70, 949–955.PubMedCrossRef Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. R., Greenbaum, M. A., & Karlin, B. E. (2013). Effectiveness of national implementation of prolonged exposure therapy in VA care. JAMA Psychiatry, 70, 949–955.PubMedCrossRef
go back to reference Foa, E., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide. Oxford: Oxford University Press. Foa, E., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide. Oxford: Oxford University Press.
go back to reference Glasgow, R. E., & Emmons, K. M. (2007). How can we increase translation of research into practice? Types of evidence needed. Annual Review of Public Health, 28, 413–433.PubMedCrossRef Glasgow, R. E., & Emmons, K. M. (2007). How can we increase translation of research into practice? Types of evidence needed. Annual Review of Public Health, 28, 413–433.PubMedCrossRef
go back to reference Glisson, C. (2002). The organizational context of children’s mental health services. Clinical Child and Family Psychology Review, 5, 233–253.PubMedCrossRef Glisson, C. (2002). The organizational context of children’s mental health services. Clinical Child and Family Psychology Review, 5, 233–253.PubMedCrossRef
go back to reference Gray, M. J., Elhai, J. D., & Schmidt, L. O. (2007). Trauma professionals’ attitudes toward and utilization of evidence-based practices. Behavior Modification, 31, 732–748.PubMedCrossRef Gray, M. J., Elhai, J. D., & Schmidt, L. O. (2007). Trauma professionals’ attitudes toward and utilization of evidence-based practices. Behavior Modification, 31, 732–748.PubMedCrossRef
go back to reference Greenhalgh, T., Glenn, R., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic literature review and recommendations for future research. Milbank Quarterly, 82, 1–35.CrossRef Greenhalgh, T., Glenn, R., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic literature review and recommendations for future research. Milbank Quarterly, 82, 1–35.CrossRef
go back to reference Hamblen, J. L., Bernardy, N. C., Sherrieb, K, Norris, F. H., Cook, J. M., Louis, C. A., et al. (under review). VA PTSD clinic director perspectives: How readiness guides provision of evidence-based PTSD treatment. Hamblen, J. L., Bernardy, N. C., Sherrieb, K, Norris, F. H., Cook, J. M., Louis, C. A., et al. (under review). VA PTSD clinic director perspectives: How readiness guides provision of evidence-based PTSD treatment.
go back to reference Institute of Medicine (US). Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington DC: National Academies Press. Institute of Medicine (US). Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington DC: National Academies Press.
go back to reference Jacobs, S. R., Weiner, B. J., & Bunger, A. C. (2014). Context matters: Measuring implementation climate among individuals and groups. Implementation Science, 9, 46.PubMedCentralPubMedCrossRef Jacobs, S. R., Weiner, B. J., & Bunger, A. C. (2014). Context matters: Measuring implementation climate among individuals and groups. Implementation Science, 9, 46.PubMedCentralPubMedCrossRef
go back to reference Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., et al. (2010). Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23, 663–673.PubMedCrossRef Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., et al. (2010). Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23, 663–673.PubMedCrossRef
go back to reference Kessler, R. C. (2000). Posttraumatic stress disorder: The burden to the individual and to society. Journal of Clinical Psychiatry, 61, 4–14.PubMed Kessler, R. C. (2000). Posttraumatic stress disorder: The burden to the individual and to society. Journal of Clinical Psychiatry, 61, 4–14.PubMed
go back to reference Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.PubMedCrossRef Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.PubMedCrossRef
go back to reference Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). The national Vietnam veterans readjustment study: Tables of findings and technical appendices. New York: Brunner/Mazel. Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). The national Vietnam veterans readjustment study: Tables of findings and technical appendices. New York: Brunner/Mazel.
go back to reference McHugo, G., Drake, R., Whitley, R., Bond, G., Campbell, K., Rapp, C., et al. (2007). Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services, 58, 1279–1284.PubMedCrossRef McHugo, G., Drake, R., Whitley, R., Bond, G., Campbell, K., Rapp, C., et al. (2007). Fidelity outcomes in the national implementing evidence-based practices project. Psychiatric Services, 58, 1279–1284.PubMedCrossRef
go back to reference Mott, J. M., Mondragon, S., Hundt, N., Beason-Smith, M., Grady, R. H., & Teng, E. J. (2014). Characteristics of veterans who initiate and complete Cognitive Processing Therapy and Prolonged Exposure for PTSD. Journal of Traumatic Stress, 27, 265–273.PubMedCrossRef Mott, J. M., Mondragon, S., Hundt, N., Beason-Smith, M., Grady, R. H., & Teng, E. J. (2014). Characteristics of veterans who initiate and complete Cognitive Processing Therapy and Prolonged Exposure for PTSD. Journal of Traumatic Stress, 27, 265–273.PubMedCrossRef
go back to reference O’Connor, B. P. (2000). SPSS and SAS programs for determiningthe number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instrumentation, and Computers, 32, 396–402. O’Connor, B. P. (2000). SPSS and SAS programs for determiningthe number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instrumentation, and Computers, 32, 396–402.
go back to reference Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88, 879.PubMedCrossRef Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88, 879.PubMedCrossRef
go back to reference Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36, 24–34.PubMedCrossRef Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36, 24–34.PubMedCrossRef
go back to reference Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38, 65–76.PubMedCentralPubMedCrossRef Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38, 65–76.PubMedCentralPubMedCrossRef
go back to reference Resick, P. A., & Schnicke, M. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park: Sage Publications. Resick, P. A., & Schnicke, M. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park: Sage Publications.
go back to reference Rogers, E. M. (1962). Diffusion of innovations. New York: Free Press. Rogers, E. M. (1962). Diffusion of innovations. New York: Free Press.
go back to reference Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.
go back to reference Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measure. Implementation Science, 9, 7.PubMedCentralPubMedCrossRef Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measure. Implementation Science, 9, 7.PubMedCentralPubMedCrossRef
go back to reference Shiner, B., D’Avolio, L. W., Nguyen, T. M., Zayed, M. H., Young-Xu, Y., Desai, R. A., et al. (2012). Measuring use of evidence based psychotherapy for posttraumatic stress disorder. Administration and Policy in Mental Health and Mental Health Services Research, 40, 311–318.CrossRef Shiner, B., D’Avolio, L. W., Nguyen, T. M., Zayed, M. H., Young-Xu, Y., Desai, R. A., et al. (2012). Measuring use of evidence based psychotherapy for posttraumatic stress disorder. Administration and Policy in Mental Health and Mental Health Services Research, 40, 311–318.CrossRef
go back to reference Solberg, L. (2009). Lessons for non-VA care delivery systems from the US Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI series. Implementation Science, 4, 9.PubMedCentralPubMedCrossRef Solberg, L. (2009). Lessons for non-VA care delivery systems from the US Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI series. Implementation Science, 4, 9.PubMedCentralPubMedCrossRef
go back to reference SPSS. (2005). Linear Mixed-Effects Modeling in SPSS: An Introduction to the MIXED Procedure (Technical Report LMEMWP-0305). Chicago: SPSS. SPSS. (2005). Linear Mixed-Effects Modeling in SPSS: An Introduction to the MIXED Procedure (Technical Report LMEMWP-0305). Chicago: SPSS.
go back to reference Stith, S., Pruitt, I., Dees, J., Fronce, M., Green, N., Som, A., et al. (2006). Implementing community-based prevention programming: A review of the literature. Journal of Primary Prevention, 27, 599–617.PubMedCrossRef Stith, S., Pruitt, I., Dees, J., Fronce, M., Green, N., Som, A., et al. (2006). Implementing community-based prevention programming: A review of the literature. Journal of Primary Prevention, 27, 599–617.PubMedCrossRef
go back to reference Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine, 43, 337–350.PubMedCentralPubMedCrossRef Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine, 43, 337–350.PubMedCentralPubMedCrossRef
go back to reference Tanielian, T. L., & Jaycox, L. H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: Rand Corporation. Tanielian, T. L., & Jaycox, L. H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: Rand Corporation.
go back to reference Tomoaia-Cotisel, A., Scammon, D. L., Waitzman, N. J., Cronholm, P. F., Halladay, J. R., Driscoll, D. L., et al. (2013). Context matters: The experience of 14 research teams in systematically reporting contextual factors important for practice change. Annals of Family Medicine, 11, S115–S123.PubMedCentralPubMedCrossRef Tomoaia-Cotisel, A., Scammon, D. L., Waitzman, N. J., Cronholm, P. F., Halladay, J. R., Driscoll, D. L., et al. (2013). Context matters: The experience of 14 research teams in systematically reporting contextual factors important for practice change. Annals of Family Medicine, 11, S115–S123.PubMedCentralPubMedCrossRef
Metadata
Title
A Quantitative Test of an Implementation Framework in 38 VA Residential PTSD Programs
Authors
Joan M. Cook
Stephanie Dinnen
Richard Thompson
Josef Ruzek
James C. Coyne
Paula P. Schnurr
Publication date
01-07-2015
Publisher
Springer US
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 4/2015
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-014-0590-0

Other articles of this Issue 4/2015

Administration and Policy in Mental Health and Mental Health Services Research 4/2015 Go to the issue