PTSD: National Center for PTSD
Dissemination and Education Within the VA
Dissemination and Education within the VA
A major focus of the National Center for PTSD's education activities is working with VA mental health practitioners to ensure the best possible care for Veterans who are suffering with the effects of traumatic stress.
PTSD Consultation Program
In February 2011, the National Center for PTSD launched a PTSD Consultation Program offering VA providers easy access to free consultation with PTSD experts. In late 2014 the Center began to offer this service beyond the VA to community providers who treat Veterans with PTSD. Consultants assist providers with questions about PTSD assessment and treatment, clinical practice, resources for PTSD care, administration and programmatic issues, and improving care for Veterans. The Program also offers a monthly lecture series featuring expert commentary on topics derived from consultation requests.
The number of consultations continued to increase in fiscal year (FY) 2014 and the Program is utilized by a variety of professionals, including psychologists, social workers, physicians, nurses, administrators, pharmacists, researchers, and others. FY 2014 was marked by an increase in repeat users of the Consultation Program as well as new users, reflective of steady growth. Consults are also provided to professionals in a number of care settings, including PTSD outpatient clinics, mental health clinics, inpatient services, and other programs such as homelessness, substance use disorder (SUD) clinics, and the Veterans Justice Outreach (VJO) program.
Program evaluation data show that providers are highly satisfied with their consultation experience and find our consultants to be knowledgeable and collaborative.
PTSD Mentoring Program
The PTSD Mentoring Program was established in 2008 by Mental Health Services (MHS) and the National Center for PTSD to support the effective delivery of PTSD treatments in specialty clinics by sharing administrative strong practices. The Program is a national network of PTSD clinical team directors and PTSD specialists within VA with support from staff at the NCPTSD Executive Division.
Each of the 21 VA regions, or Veterans Integrated Service Networks (VISNs), has two experienced and expert clinic directors who serve as PTSD mentors to the PTSD program directors and PTSD specialists in their VISN (mentees). The Program helps to meet the increased demand for treatment by restructuring existing programs and by implementing effective administrative and clinical practices. This happens through monthly VISN and national calls, an email list and newsletter, one-on-one conversations, and occasional face-to-face meetings.
Formal evaluations of the Program have shown that program participation has helped clinicians improve their clinic design, offered solutions to their clinic problems, and aided them in their work. Participants report that the Program helps improve morale in the field and that they find it invaluable to be part of this network of specialty care providers.
Dissemination of Evidence-Based Treatments
Prolonged Exposure and Cognitive Processing Therapy. Initiated in fiscal year (FY) 2007 at the direction of VA Mental Health Services (MHS), the rollouts of two evidence-based therapies for PTSD, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) continue to be a highlight of the National Center for PTSD's educational endeavors. Over the past few years, both programs have created extensive trainings and support materials including manuals, videos, and CD-ROMs. Additionally, both programs now have processes in place to certify both clinicians and trainers. In a continued effort to de-centralize the dissemination of the therapies, local experts are being trained as trainers and consultants.
To date, 1,800 clinicians have participated in the 4-day PE trainings along with 17 trainers and 64 consultants. Outcomes of PE measured during training cases continued to show a clinically-significant mean reduction of 15 points on the PTSD Checklist. Over 7,700 VA and military clinicians have been trained in CPT. There are now 53 VISN-level trainers, 8 Department of Defense trainers, and 6 Rehabilitation Counseling Services (Veteran Center) trainers in addition to 10 National Roll-out Trainers. Online courses for both interventions are available.
Acceptance and Commitment Therapy. The National Center for PTSD collaborated with the Sierra-Pacific MIRECC and Mental Health Services to continue national implementation of Acceptance and Commitment Therapy (ACT) for depression (a mental health problem that is highly co-morbid with PTSD) and co-occurring anxiety. During FY14, three trainings took place, including an ACT consultant training (with 12 VA staff in attendance) and two 3-day workshops (with 78 in attendance). Overall, there have been 19 trainings on ACT for depression with 658 trainees enrolled. Mental health providers from a variety of clinics and from all VISNs have participated. Six monthly "Office Hours" calls and an ACT mini-lecture series are provided in addition to the implementation training, as well as an ACT for Depression SharePoint site, in support of this effort.
Practice-Based Implementation Network (PBI Network)
Clinical Training Program. The PBI Network was launched in 2014 as part of a Joint Incentive Funds (JIF) project in collaboration with Mental Health QUERI, VISN 6 MIRECC, and the Department of Defense (DoD). The PBI Network is a national partnership that brings together stakeholders (providers, clinic managers, and leadership) in an effort to implement and evaluate innovative, evidence-based best practices in PTSD treatment. The first PBI Network initiative, "Bringing Routine Outcomes Monitoring into PTSD Care," is a quality improvement project that aims to increase use of outcomes monitoring in PTSD treatment settings. Eighteen VA and 10 DoD clinics have joined the PBI Network to implement routine PTSD outcomes monitoring, a practice recognized by the Institute of Medicine in 2014 as vital, but underutilized, in PTSD treatment. We will continue to expand the network and implement a variety of evidence-based and best practices, creating a knowledge network that will benefit clinicians, administrators, researchers, and ultimately the Veterans who will have better access to top notch care as a result of these efforts.
Rural Mental Health Outreach Initiative
In 2014, the National Center for PTSD began efforts to help clinicians improve the quality of care delivered to Veterans with PTSD at the White River Junction VA medical Center (WRJ VAMC) and associated Community-Based Outpatient Clinics (CBOCs). This is an education and training outreach project aimed at promoting evidence-based psychotherapy and safe medication choices for PTSD, particularly among Veterans in rural areas. Using an academic detailing model, a staff clinical mental health pharmacist provides outreach visits to deliver customized education related to prescribing practices, barrier-resolution strategies for clinicians and patients, and telehealth and in-person consultation of care reviews with clinicians in the WRJ VAMC. The long term goal of this initiative is to implement a similar model in other rural VA Medical Centers across the country.