Pilot outcomes of cognitive processing therapy implementation in military health system outpatient behavioral health clinics.

Enterprise data indicates that U.S. service members (SMs) with posttraumatic stress disorder (PTSD) may not receive an evidence-based treatment (EBT) or may receive an EBT with low fidelity to the core components. Successful delivery of EBTs requires provider training and ongoing supervision/consultation, adjustment of clinic processes and structure, and leadership support. The Department of Defense (DoD) Practice-Based Implementation (PBI) Network is a dedicated team of implementation science specialists that support the integration of EBTs into clinical practice in the Military Health System (MHS). The PBI Network conducted a Cognitive Processing Therapy (CPT) pilot to investigate the acceptability and feasibility of a novel trauma specialist implementation approach proposed by South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR). This approach, CPT Trauma Specialist (CPT-TS), called for training designated behavioral health (BH) therapists as the primary CPT providers in their clinics. In collaboration with the Uniformed Services University Center for Deployment Psychology, the PBI Network provided training and consultation to 26 providers across 13 MHS BH clinics and supported ongoing facilitation. Despite provider interest and clinic leadership support, less than half of the pilot provider participants were able to meet the consultation and CPT delivery requirements for designation as a CPT trauma trained specialist. Prevalent implementation barriers included lack of adequate clinic resources, provider challenges balancing clinical and military-related duties, the need to focus on high-risk patients, and other military system-related constraints. These findings highlight the need for implementation scientists to examine alternatives to traditional training models and identify fidelity-consistent adaptations that allow for delivery of evidence-based care within highly constrained systems of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Practice-Based Implementation (PBI) Network: Technology (Tech) into Care pilot.

Technology can support the use of evidence-based behavioral health treatments, as well as serve as a link to care to improve patient engagement and adherence to treatment. While research suggests that mobile applications (apps) specifically have the potential to enhance the delivery of behavioral health treatment, little guidance exists on how clinicians can effectively and safely integrate mobile apps into their clinical practice. The purpose of this paper is to describe the Department of Defense Practice-Based Implementation (PBI) Network's approach to implementation and present the results of the Technology (Tech) into Care pilot. The PBI Network conducted this pilot to address providers' knowledge gaps regarding the integration of mobile apps into behavioral health care within the Military Health System (MHS) and examine the feasibility of widespread dissemination of the practice change in the MHS. A mixed-method design guided by the Promoting Action on Research Implementation in Health Services framework was used to evaluate the approach and identify facilitators and barriers to practice change. Positive preliminary support for the feasibility of the Tech into Care approach was demonstrated in improvements in providers' knowledge, comfort, and perceived level of preparation to integrate mobile apps into care. Organizational challenges including time constraints and staff turnover negatively impacted implementation success. The PBI Network Tech into Care implementation approach is a feasible method to address knowledge gaps related to the integration of mobile apps into clinical practice within the MHS. Contextual factors, such as competing time demands, often impede providers' ability to effectively integrate mobile apps into care.