Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration

作者：Sayer Nina A; Rosen Craig S; Bernardy Nancy C; Cook Joan M; Orazem Robert J; Chard Kathleen M; Mohr David C; Kehle Forbes Shannon M; Eftekhari Afsoon; Crowley Jill; Ruzek Josef I; Smith Brandy N; Schnurr Paula P

来源：Administration and Policy in Mental Health and Mental Health Services Research, 2017, 44(6): 904-918.

DOI：10.1007/s10488-017-0809-y

• Evidence-based practices
• Mental health services
• Posttraumatic stress disorder
• Organization
• Mixed methods
• Implementation

Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment. Strategies to improve reach of evidence-based psychotherapies should attend to organizational and team-level factors.