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2015 HSR&D/QUERI National Conference Abstract

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3111 — Sustained Use of Evidence-Based Psychotherapy by Graduates of the Prolonged Exposure Training Program

Rosen CS, National Center for PTSD Dissemination & Training Division; Crowley JJ, National Center for PTSD Dissemination & Training Division; Eftekhari A, National Center for PTSD Dissemination & Training Division; Kuhn ER, National Center for PTSD Dissemination & Training Division; Smith BN, National Center for PTSD Dissemination & Training Division; Trent LR, National Center for PTSD Dissemination & Training Division; Ruzek JI, National Center for PTSD Dissemination & Training Division;

Objectives:
VA has invested millions of dollars in training thousands of clinicians in evidence-based psychotherapies (EBPs), including Prolonged Exposure Therapy for PTSD (PE). Clinical data confirm that PE is highly effective in Veterans. We here examine how use of PE was sustained over time.

Methods:
556 VA clinicians who completed the National PE Training Program (four days of workshop training followed by case consultation on two or more training cases) were surveyed 6 months and 18 months after completing case consultation. Survey measures assessed perceived characteristics of PE, clinicians' control over treatment processes, clinical setting, and caseload. PTSD clinic workload data were obtained from Northeast Program Evaluation Center reports.

Results:
Most PE Training Program graduates were using PE six months (76%) and 18 months (70%) after training, but usually with only 1 or 2 Veterans at a time. Higher PE use at 18 month follow-up was predicted by working in a specialty outpatient PTSD program (Poisson b = .11, p < .001), ability to promote PE to colleagues (b = .28, p < .001), and seeing PE as effective (b = .16, p < .001). PE was used less often in PTSD clinics that had more patients per provider (beta = -.21, p < .001) and more visits per patient (beta = -.24, p < .001).

Implications:
Program graduates are using PE successfully, but its penetration is limited. Workload and buy-in from colleagues appear to be critical influences on PE use. PE use was lower among clinicians with large caseloads and those who focused on keeping patients stable rather than promoting recovery. Whether clinicians used another evidence-based PTSD treatment, such as Cognitive Processing Therapy, in lieu of PE was not assessed.

Impacts:
PE is widely adopted but used on a limited basis. The release of EBP chart note templates can aid managers in monitoring EBP use. Current initiatives to decentralize EBP training should be matched with strategies to build local support for EBPs. It is also important that adequate staffing to deliver EBPs be maintained as more PTSD care is shifted from specialized PTSD programs to Behavioral Health Interdisciplinary Teams.