Expanding access to evidence-based psychotherapy in VA settings: implementation of the brief cognitive behavioral therapy for depression program

Frontiers in Health Services

Health Services

Andrew Robinson¹  Raquel D. Gonzalez²  Darrell Zeno²  Shubhada Sansgiry³  Jeffrey A. Cully⁴  Derrecka Boykin⁴  Kristen Sorocco⁵  Richard B. Roberson⁶  Joseph Mignogna⁷  Jennifer Broderick-Mcdaniel⁸ 

[1] HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States;HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States;VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center Houston, TX, United States;HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States;VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center Houston, TX, United States;Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States;HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States;VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center Houston, TX, United States;Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States;Oklahoma Veterans Affairs Medical Center, Oklahoma City, OK, United States;University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States;Primary Care Mental Health Integration, Audie L. Murphy VA Hospital, South Texas Veterans Health Care System, San Antonio, TX, United States;Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States;Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;VISN 17 Primary Care Mental Health Integration, VA Heart of Texas Health Care Network, Arlington, TX, United States;

关键词: rural;    RE-AIM;    evidence-based psychotherapy;    veterans;    implementation science;    brief CBT;    telehealth;    depression;   

DOI  :  10.3389/frhs.2023.1210286

 received in 2023-04-22, accepted in 2023-09-26,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionEvidence-based psychotherapies (EBPs) are effective for mental health conditions, but access to these services remains limited and rural Veterans are particularly underserved. Specialized implementation and dissemination programs are needed to improve access to known EBPs.MethodsThe current project sought to improve access to a known EBP—brief Cognitive Behavioral Therapy for depression (Brief CBT). Diverse Veterans and those from rural settings were a focus of this work. Aligned with the RE-AIM framework, a multifaceted implementation program was used to train and support VHA providers in their use of Brief CBT in VHA mental health settings, with specific outreach efforts made to providers at VHA Community-Based Outpatient Clinics (CBOCs) where rural Veterans often receive care. Evaluation included all facets of RE-AIM with a particular focus on adoption, effectiveness, and maintenance.ResultsDuring the first two years, over 40 VHA facilities adopted the program across four regional networks. Eighty-three providers were approached, and 54 (65.1%) providers completed the training and are delivering the intervention. A total of 688 Veterans, 174 rural (25.7%), received 2,186 sessions (average of 3.5 sessions per Veteran). Veterans receiving Brief CBT with elevated depression scores who completed three or more sessions were found to have significant symptom reductions of 4.6 points (first to last available evaluations).DiscussionImplementation efforts of Brief CBT resulted in rapid uptake and significant clinical impact on Veterans. Rural outreach efforts, including targeted training for CBOC providers and use of tele-mental health, enhanced availability of EBP services for rural Veterans.

【 授权许可】

Unknown   
© 2023 Mignogna, Boykin, Gonzalez, Robinson, Zeno, Sansgiry, Broderick-Mcdaniel, Roberson, Sorocco and Cully.