Symposium 27 - Determinants of PTSD EBP receipt across the continuum of care: increasing generalizability and addressing structural barriers through adaptation

Chair(s)

• 

  Rebecca Sripada, ABPP, Ph.D. (she/her/hers)

  Psychologist
  University of Michigan
  Ann Arbor, MI, United States

Discussant(s)

• 

  Rebecca Sripada, ABPP, Ph.D. (she/her/hers)

  Psychologist
  University of Michigan
  Ann Arbor, MI, United States

Presenter(s)

• 

  Carmen McLean, Ph.D. (she/her/hers)

  Clinical Psychologist
  National Center for PTSD
  Menlo Park, CA, United States
• 

  Erika Roberge, Ph.D. (she/her/hers)

  Salt Lake City VA, University of Utah School of Medicine
  Salt Lake City, Utah, United States

  Handouts
• 

  Rebecca Sripada, ABPP, Ph.D. (she/her/hers)

  Psychologist
  University of Michigan
  Ann Arbor, MI, United States
• SL

  Stefanie LoSavio, ABPP, Ph.D.

  Assistant Professor
  The University of Texas Health Science Center at San Antonio
  San Antonio, TX, United States

Evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are highly effective in randomized controlled trials and yet underutilized and underperforming in general clinical practice (Maguen et al., 2023). The Veterans Health Administration (VHA) and Department of Defense (DoD) provide excellent forums in which to study how to best implement PTSD EBPs, given the unified nature of the health systems and the elevated presence of PTSD in military and veteran populations. Our research has identified three primary drivers for EBP underutilization and underperformance: one is constraints of care delivery models. The static version of once-a-week or once every few weeks does not work well for active-duty service members and young adult veterans. Providing massed (i.e. 2-5x weekly) treatment provides an opportunity for concentrated work and focus to alleviate PTSD symptoms in a short amount of time and allow individuals to return to duty/regular routines (Wachen et al., 2019). The second potential driver is setting of EBP delivery. Delivering EBPs solely in specialty mental health care requires that individuals with PTSD navigate multiple systems in order to receive high quality care. Providing EBPs at the point of care (i.e. where individuals first access care, such as primary care settings) could represent a critical next step to improving access and reducing barriers to receive an EBP (Rauch et al., 2023). The third driver is lack of trained clinicians. When the mental health workforce is in flux and turnover is high, developing sustainable EBP training models that yield high quality psychotherapy is crucial for preserving continuity of services (Rosen et al., 2017). This symposium will address these implementation barriers using a variety of analytical techniques: secondary analysis of electronic health record data, mixed methods, and quality improvement techniques. We will present a series of studies outlining the landscape of current EBP utilization and progress on current training initiatives and adaptations to improve generalizability. Dr. Carmen McLean will present data assessing the frequency of EBP receipt and predictors of adequate EBP receipt in DoD. Dr. Sripada will present feasibility data on delivering a PTSD EBP in primary care. Dr. Roberge will present data on determinants of massed EBP in VA. Dr. LoSavio will present results from a EBP training initiative on competency assessment and how this practice can enhance patient outcomes. The speakers will also identify moderators of EBP receipt and EBP outcomes. Consistent with the conference theme, they will highlight ways in which EBP service delivery models can address structural determinants, including contextual, cultural, and identity-based factors. By addressing these determinants, the proposed initiatives will help lay the groundwork for increasing the reach and generalizability of EBPs.

Presentations:

• 5:04 PM - 5:18 PM CST

  (SYM 27) Treatment of PTSD in the Military Health System: Which Patients Receive Evidence Based Psychotherapy?
  

  Speaker: Carmen McLean, Ph.D. (she/her/hers) – National Center for PTSD

  Co-author: Jeffrey Cook, PhD – Center for Deployment Psychology

  Co-author: Christopher Haddock, PhD – NDRI-USA

  Co-author: Chunki Fong, PhD – NRDI-USA

  Co-author: Craig Rosen, PhD – National Center for PTSD, Dissemination and Training Division
• 5:18 PM - 5:32 PM CST

  (SYM 27) Mixed-methods Analysis of the Feasibility, Acceptability, and Considerations for Implementation of Massed Ebps for PTSD into VA Outpatient Clinics
  

  Speaker: Erika M. Roberge, Ph.D. (she/her/hers) – Salt Lake City VA, University of Utah School of Medicine

  Co-author: Diana Bennett, PhD – VA Salt Lake City Health Care System

  Co-author: Harrison Weinstein, Ph.D. – Salt Lake City VA Healthcare System & The University of Utah
• 5:32 PM - 5:46 PM CST

  (SYM 27) Implementing Brief Evidence-based PTSD Treatment in Primary Care Clinics: Provider Perspectives on Challenges and Opportunities
  

  Speaker: Rebecca Sripada, ABPP, Ph.D. (she/her/hers) – University of Michigan

  Co-author: Heather Walters, MS – VA Center for Clinical Management Research

  Co-author: Margaret Venners, MSW – National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System

  Co-author: Sheila A.M. Rauch, Ph.D., ABPP – Emory University
• 5:46 PM - 6:00 PM CST

  (SYM 27) Assessing Provider Competency During Training in Written Exposure Therapy for Posttraumatic Stress Disorder
  

  Speaker: Stefanie LoSavio, ABPP, Ph.D. – The University of Texas Health Science Center at San Antonio

  Co-author: Bailee Schuhmann, PhD (she/her/hers) – University of Texas Health Sciences Center for San Antonio

  Co-author: Cy Pattee, MPH – The University of Texas Health Science Center at San Antonio

  Co-author: Brooke Fina, LCSW – University of Texas Health Science Center at San Antonio

  Co-author: David Rozek, ABPP, Ph.D. – University of Texas Health Science Center at San Antonio

  Co-author: Katy Dondanville, PsyD, ABPP – The University of Texas Health Science Center at San Antonio