title: Clinician Documentation on Receipt of Trauma-Focused Evidence-Based Psychotherapies in a VA PTSD Clinic.
abstract: The U.S. Department of Veterans Affairs (VA) is implementing two trauma-focused, evidence-based psychotherapies (TF-EBPs) for posttraumatic stress disorder (PTSD): cognitive processing therapy and prolonged exposure therapy (PE). Veterans with PTSD often do not receive these treatments, and little is known about the reasons veterans may not receive TF-EBPs. The aim of this qualitative study was to summarize clinician-reported reasons in medical records for nonreceipt of TF-EBPs. All veterans (N = 63) identified through PTSD screening who were newly engaged in mental health care and received individual evaluations in a PTSD specialty clinic in fiscal year 2008 were included in the sample. Content analysis of electronic medical records revealed multiple potential reasons for nonreceipt of TF-EBPs including referral to other PTSD treatments, other clinical priorities, poor engagement in care, practical barriers, negative beliefs, and receipt of care in other settings. Eight veterans (13%) initiated TF-EBPs. Further interventions to promote engagement in PTSD treatment are warranted.
authors.affiliation: Mental Health & Clinical Neurosciences Division, Portland VA Medical Center, PO Box 1034, Mail code: P3MHDC, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA. Mary.Lu@va.gov.
authors.forename: Mary W
authors.initials: MW
authors.lastname: Lu
authors.affiliation: Mental Health & Clinical Neurosciences Division, Portland VA Medical Center, PO Box 1034, Mail code: P3MHDC, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA. Jane.Plagge@va.gov.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Plagge
authors.affiliation: Mental Health & Clinical Neurosciences Division, Portland VA Medical Center, PO Box 1034, Mail code: P3MHDC, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA. Mary.Marsiglio@va.gov.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Marsiglio
authors.affiliation: Mental Health & Clinical Neurosciences Division, Portland VA Medical Center, PO Box 1034, Mail code: P3MHDC, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA. Steven.Dobscha@va.gov.|Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA. Steven.Dobscha@va.gov.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D004282:Documentation; D057286:Electronic Health Records; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D055815:Young Adult