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RRP 08-239 – QUERI Project

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RRP 08-239
Evaluating Facilitation of CBT Implementation in VA Primary Care
Dean Blevins PhD
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
No. Little Rock, AR
Funding Period: October 2008 - March 2009

BACKGROUND/RATIONALE:
The Department of Veterans Affairs has mandated the adoption of evidence-based psychotherapies. There is a need for simple yet effective implementation strategies to promote adoption of complex practices, such as psychotherapies, however, we do not know if the strategies available are cost effective, and we do not know how individual site characteristics might interact with their effectiveness. This pilot built upon a parent study providing training in CBT use to 22 clinics in VISN 16. The focus of this parent study was to assess the impact of external facilitation on the implementation of Cognitive Behavior Therapy.

OBJECTIVE(S):
There were three objectives in the present study: 1) Assess organizational readiness to change at sites and its effects upon CBT implantation at follow-up; 2) estimate the direct costs of external facilitation; and 3) examine the relationship between the costs of external facilitation and site-level readiness to change. Finally, a formative evaluation was conducted to explore the barriers and value of external facilitation to implementation.

METHODS:
A mixed methods approach was employed to pursue study objectives. Participants included 26 providers across 19 sites for the first objective and the remaining objectives included only intervention site participants (i.e., those receiving external facilitation), which were 12 providers across 9 sites. All providers completed a survey of organizational readiness to change. Direct costs of external facilitation (intervention participants only) were estimated by examining contact logs between therapists and the external facilitator. The formative evaluation involved key informant interviews with 6 participants across the intervention sites.

FINDINGS/RESULTS:
Findings suggested that sites were not statistically different 4 months after external facilitation began; however, intervention sites evinced greater readiness to change as a trend. The only facets of readiness to change that suggest associations with implementation are Context and Facilitation. Direct costs of external facilitation were low and suggest about $88 for each additional hour of CBT provided at follow-up. Cost was not associated with readiness to change. The formative evaluation emphasized the importance of leadership collaboration in the implementation of manualized therapies such as CBT.

IMPACT:
This pilot study provides preliminary information concerning the importance of readiness to change on implementation of CBT. While statistical significance was not achieved in this study, trends suggest that readiness is possibly an important area that may interact with external facilitation to implementing evidence-based therapies. Additionally, this study demonstrated that the costs of external facilitation were very low and may be an important strategy to consider when initiating new trainings within the VA health care system.

PUBLICATIONS:

Journal Articles

  1. Kauth MR, Sullivan G, Blevins D, Cully JA, Landes RD, Said Q, Teasdale TA. Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study. Implementation science : IS. 2010 Oct 13; 5:75.
Conference Presentations

  1. Kauth M, Blevins D, Landes R, Sullivan G. Using External Facilitation in the VA to Implement Psychotherapies. Poster session presented at: National Institutes of Health Conference on the Science of Dissemination and Implementation: Methods and Measurement; 2010 Mar 15; Bethesda, MD.
  2. Kauth MR, Blevins D, Sullivan G, Cully J, Landes R. Factors related to implementing brief cognitive behavioral therapy (CBT) in VA clinics: A pilot study. Paper presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2009 Jul 21; Baltimore, MD.
  3. Said Q, Blevins D, Kauth M, Sullivan G. Facilitation in implementing CBT among veterans: Analysis of therapist time in facilitation and CBT provision. Poster session presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2009 Jul 21; Baltimore, MD.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: none
Keywords: none
MeSH Terms: none

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