The VA has recently taken an important step in promoting use of evidence-based services by initiating development of a joint VA-DOD Practice Guideline for Management of Traumatic Stress (PTSD). The Guideline advocates application of a variety of evidence-based practices for treatment of veterans with PTSD. In addition, the National Center for PTSD (NCPTSD) has recently developed an Iraq War Clinician Guide to guide treatment of returning personnel with PTSD (National Center for PTSD & Walter Reed Army Medical Center, 2003; Ruzek et al., 2003) and generally, prepare VA mental health clinicians for returning veterans. However, despite the clear recent articulation of “best practices” in the PTSD-PG and the Iraq War Clinician Guide, many of the recommended practices are not widely implemented in the VA Health Care System. Staff awareness about PTSD and efficacious treatments, knowledge and skill deficits, clinician attitudes, and institutional barriers all prevent widespread dissemination of recommended practices. The current project seeks to develop a web-based methodology of dissemination to encourage increase in awareness, knowledge, and skills, while decreasing both clinician and institutional barriers to implementation.
The purpose of the project is to develop and evaluate a mechanism – “Virtual Innovation Partnership” (“VIP”) – for the dissemination of Practice Guideline/empirically-supported Post-Traumatic Stress Disorder (PTSD) assessment and treatment practices. VIP is an education and support infrastructure that combines use of empirically-supported practitioner behavior change methods, electronic and face-to-face marketing, and web-based evaluation. It is designed to maximize clinician choice regarding elements of practice change to increase rates of dissemination. In addition to development of this mechanism, this phase of the project utilized a focus group format to gather qualitative information from practitioners and leadership to determine highest priority practices.
Focus groups were held with six total clinican groups in the VISN: 3 PTSD Clinical Teams (PCT), 2 Residential Programs, and 1 Mental Health Clinic that services a high percentage of veterns with PTSD. In addition, individual focus groups were conducted with key leadership in mental health and PTSD in the region. Information was collected on PTSD practices with highest priority and ease of implementation for targeted dissemination and implmentation in subsequent work.
Focus groups have been conducted with 17 clinicians and 3 members of PTSD leadership. Findings revealed a strong interest by clinicians and leadership in web-based technology to facilitate PTSD training in the region. Clinicians also reported training needs in advanced methods of assessment of PTSD symptomology, treatment outcome, and assessment of warzone experiences and risk factors. In addition, clinicians and leadership cited needs in the area of Cognitive-Behavioral treatment with Exposure for PTSD, as well as in protocols for PTSD Education, Anger Management, Family/Couples interventions, and treatment for PTSD/Substance Abuse dual diagnosis patients.
Data collected in this phase helps to identify key practices of highest priority to both practitioners and leadership in the dissemination of PTSD best practices, and will provide a basis for further dissemination efforts and study.
- Ruzek JI, Friedman MJ, Murray S. Towards a PTSD knowledge management system in Veterans Health Care. Psychiatric Annals. 2005 Dec 1; 35:911-920.
- Ruzek JI. Virtual innovation partnership: Overview of a dissemination system. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2005 Nov 1; Toronto, Canada.