title: A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration.
abstract: Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4-23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322-1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA. craig.rosen@va.gov.|Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. craig.rosen@va.gov.
authors.forename: C S
authors.initials: CS
authors.lastname: Rosen
authors.affiliation: School of Social Work, Saint Louis University, Saint Louis, MO, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Matthieu
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.|Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Wiltsey Stirman
authors.affiliation: Evaluation Division, National Center for PTSD, VA Connecticut Health Care System, West Haven, CT, USA.|Yale School of Medicine, NEPEC/182, 950 Campbell Avenue, West Haven, CT, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Cook
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.
authors.forename: S
authors.initials: S
authors.lastname: Landes
authors.affiliation: Executive Division, National Center for PTSD, Veterans Affairs Medical Center, White River Junction, VT, USA.|Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: N C
authors.initials: NC
authors.lastname: Bernardy
authors.affiliation: Cincinnati Department of Veterans Affairs (VA) Medical Center, Cincinnati, OH, USA.|University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Chard
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.
authors.forename: J
authors.initials: J
authors.lastname: Crowley
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.
authors.forename: A
authors.initials: A
authors.lastname: Eftekhari
authors.affiliation: South Texas Veterans Health Care System, San Antonio, TX, USA.|The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: E P
authors.initials: EP
authors.lastname: Finley
authors.affiliation: Executive Division, National Center for PTSD, Veterans Affairs Medical Center, White River Junction, VT, USA.|Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Hamblen
authors.affiliation: Executive Division, National Center for PTSD, Veterans Affairs Medical Center, White River Junction, VT, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Harik
authors.affiliation: Women's Health Sciences Division at VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA.|Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Kehle-Forbes
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Meis
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Osei-Bonsu
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Rodriguez
authors.affiliation: Ralph H. Johnson VA Medical Center, Charleston, SC, USA.|Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Ruggiero
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.|Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.|Palo Alto University, Palo Alto, CA, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Ruzek
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.
authors.forename: B N
authors.initials: BN
authors.lastname: Smith
authors.affiliation: Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-PTSD), Menlo Park, CA, 94025, USA.|Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Trent
authors.affiliation: Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.|Veterans Affairs Medical Center, White River Junction, VT, USA.
authors.forename: B V
authors.initials: BV
authors.lastname: Watts
mesh_terms: D004059:Diffusion of Innovation; D055317:Evidence-Based Practice; D006801:Humans; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Competency-based training; Diffusion of innovation; Evidence-based practice; Implementation science; Posttraumatic stress disorders; Psychotherapy; Veterans