Post-training Beliefs, Intentions, and Use of Prolonged Exposure Therapy by Clinicians in the Veterans Health Administration.
To examine how changes in beliefs during the training process predict adoption of prolonged exposure therapy (PE) by veterans health administration clinicians who received intensive training in this evidence-based treatment. Participants completed a 4-day PE workshop and received expert consultation as they used PE with two or more training cases. Participants were surveyed prior to the workshop, after the workshop, after case consultation (n = 1.034), and 6 months after training (n = 810). Hierarchical regression was used to assess how pre-training factors, and changes in beliefs during different stages of training incrementally predicted post-training intent to use PE and how many patients clinicians were treating with PE 6 months after training. Post-training intent to use PE was high (mean = 6.2, SD = 0.81 on a 1-7 scale), yet most participants treated only 1 or 2 patients at a time with PE. Pre-training factors predicted intent to use and actual use of PE. Changes in beliefs during the workshop had statistically significant yet modest effects on intent and use of PE. Changes in beliefs during case consultation had substantial effects on intent and actual use of PE. Pre-training factors and changes in beliefs during training (especially during case consultation) influence clinicians' adoption of PE. Use of PE was influenced not only by its perceived clinical advantages/disadvantages, but also by contextual factors (working in a PTSD specialty clinic, perceived control over one's schedule, and ability to promote PE to patients and colleagues).
Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. josef.ruzek@va.gov.|Palo Alto University, Palo Alto, CA, USA. josef.ruzek@va.gov.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA. josef.ruzek@va.gov.
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http://orcid.org/0000-0003-4099-6431
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Ruzek
Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
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Eftekhari
Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
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Crowley
Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
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Kuhn
Education Development Center Inc., New York, NY, USA.|Bloomberg School of Public Health, Johns Hopkins University (Previously affiliated with Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, DC), Baltimore, MD, USA.
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Karlin
Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
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Rosen
D005260:Female; D006801:Humans; D007171:Implosive Therapy; D033182:Intention; D008297:Male; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
Implementation; Intentions; Post-training beliefs; Posttraumatic stress disorder; Training; Use of prolonged exposure therapy by clinicians in the veterans health administration