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Health Services Research & Development

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HSR&D In Progress

December 2019

In This Issue: Advancements in VA Mental Healthcare
» Table of Contents

Increasing Reach of Evidence-Based Psychotherapies in Community-Based Outpatient Clinics

Feature Article

Evidence-based psychotherapies (EBPs) have demonstrated effectiveness for numerous presenting problems including PTSD, depression, and anxiety. Rates of these disorders are elevated in Veterans, creating a significant public health impact. Untreated mental health diagnoses increase risk of suicide, further elevating the need for effective treatments. Efforts to treat these mental health problems within the VA healthcare system have largely been addressed through national EBP rollouts. These EBP rollouts have been disseminated broadly, yet limited uptake has been demonstrated across VA settings, especially in Community Based Outpatient Clinics (CBOCs).

Uptake of  EBPs through CBOCs is crucial to increase timeliness and efficiency in mental healthcare as more than half of Veterans utilizing the VA system go to CBOCs for care. Moreover, Veterans presenting to rural CBOCs are receiving significantly fewer mental health appointments compared to urban CBOCs, highlighting a discrepancy in access to care by location.  Most of the research on EBP implementation has been done outside of the CBOC setting. Identifying what care Veterans in CBOCs are getting, why they may not be getting EBPs, and how to meet the needs of CBOC providers is vital to enhancing access to EBPs through tailored interventions, including in rural settings. To maximize the likelihood of broad EBP implementation in CBOCs, it is essential that implementation strategies are feasible and acceptable in CBOCs, which includes considering both rural and urban settings.

This ongoing HSR&D study (October 2019 – September 2020) will maximize a unique opportunity to understand the potential fit of alternative approaches for the delivery of evidence-based psychotherapies in CBOCs to enhance reach and sustainment of such therapies. The research team [Co-Investigators: Dr. Karen Drummond, HSR&D’s Center for Mental Healthcare & Outcomes Research (CeMHOR); Dr. Shannon Wiltsey Stirman, National Center for PTSD, VA Palo Alto Healthcare System; and Dr. Cassidy Gutner, Boston University School of Medicine] will be guided by evidence-based frameworks and will use a stakeholder advisory board to produce expert recommendations to enhance implementation strategies in rural and urban CBOCs. With input from operational partners, the resulting products have the potential to significantly improve timeliness and efficiency in EBP implementation in CBOCs across rural and urban settings.


None to date.

Impact and Next Steps

Overall, this study will advance national efforts to maximize delivery of best clinical practices for CBOCs in rural and urban settings – and will maximize efficiency and timeliness of mental healthcare for Veterans. Next steps will be to disseminate findings through an IIR submission that will allow for testing of clinical recommendations and tailorable scale-up strategies for increasing access to, and use of, EBPs in rural and urban CBOCs.

Principal Investigator: Katherine Iverson, PhD, is part of VA’s National Center for PTSD and HSR&D’s Center for Healthcare Organization & Implementation Research (CHOIR) in Boston, MA.


None to date.

View study abstract

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