Evaluation of an Implementation Intervention to Increase Reach of Evidence-Based Psychotherapies for PTSD in US Veterans Health Administration PTSD Clinics

Nina A. Sayer, Nancy C. Bernardy, Matthew Yoder, Jessica L. Hamblen, Craig S. Rosen, Princess E. Ackland, Shannon M. Kehle-Forbes, Barbara A. Clothier, Paula P. Schnurr, Robert J. Orazem, Siamak Noorbaloochi

Research output: Contribution to journalArticlepeer-review


To evaluate an implementation intervention to increase the uptake, referred to as reach, of two evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) in Veterans Health Administration (VHA) PTSD specialty clinics. The implementation intervention was external facilitation guided by a toolkit that bundled strategies associated with high EBP reach in prior research. We used a prospective quasi-experimental design. The facilitator worked with local champions at two low-reach PTSD clinics. Each intervention PTSD clinic was matched to three control clinics. We compared the change in EBP reach from 6-months pre- to post-intervention using Difference-in-Difference (DID) effect estimation. To incorporate possible clustering effects and adjust for imbalanced covariates, we used mixed effects logistic regression to model the probability of EBP receipt. Analyses were conducted separately for PTSD and other mental health clinics. 29,446 veterans diagnosed with PTSD received psychotherapy in the two intervention and six control sites in the two 6-month evaluation periods. The proportion of therapy patients with PTSD receiving an EBP increased by 16.98 percentage points in the intervention PTSD clinics compared with.45 percentage points in the control PTSD clinics (DID = 16.53%; SE = 2.26%). The adjusted odd ratio of a patient receiving an EBP from pre to post intervention was almost three times larger in the intervention than in the control PTSD clinics (RoR 2.90; 95% CI 2.22–3.80). EBP reach was largely unchanged in other (not PTSD specialty) mental health clinics within the same medical centers. Toolkit-guided external facilitation is a promising intervention to improve uptake of EBPs in VHA. Toolkits that pre-specify targets for clinic change based on prior research may enhance the efficiency and effectiveness of external facilitation. Trial registration ISRCTN registry identifier: ISRCTN65119065. Available at https://www.isrctn.com/search?q=ISRCTN65119065.

Original languageEnglish (US)
Pages (from-to)450-463
Number of pages14
JournalAdministration and Policy in Mental Health and Mental Health Services Research
Issue number3
StatePublished - May 2021

Bibliographical note

Funding Information:
This work was supported by a VA HSR&D Implementation Supplement (CRE 18–002). The sponsor was not involved in any aspect of the study’s design and conduct; data collection, management, analysis, or interpretation of data; or in the preparation, review or approval of the manuscript. The findings and conclusions presented in this manuscript are those of the authors and do not necessarily represent the views of the VA or HSR&D. Acknowledgements

Publisher Copyright:
© 2020, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.


  • Evidence-based psychotherapy
  • Facilitation
  • Implementation strategies
  • Posttraumatic stress disorder
  • Veterans

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.


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