Symposium 1 – October 13, 2011

1. Dissemination of Prolonged Exposure Therapy (PE) in VHA: Exploring Factors Related to Sustained Clinicial Attitude and Behavior Chaneg in a Large-Scale Implementation Effort.
Presentation Slides       Video of Presentation

Presenter:    Josef Ruzek
Authors:    Afsook Eftekhari, Jill J. Crowley, Josef I. Ruzek, Craig Rosen, National Center for PTSD, VA Palo Alto Health Care System, and Brad Karlin, VA Central Office

Abstract:    Since September 2007, approximately 1200 VA clinicians have successfully received training in the delivery of Prolonged Exposure Therapy (PE) across the 4 phases of the training initiative. During the current presentation, the PE train-the-trainer model will be discussed and several factors affecting the successful delivery of this model will be addressed, including systems, practitioner, and patient variables related to the dissemination, adoption, and implementation of the treatment.  Specifically, issues of implementation fidelity and sustainability will be examined within the context of both training and outcomes. Program evaluation results suggest the effectiveness of the train-the-trainer model with regard to impacting clinician’s beliefs and attitudes about PE. Results illuminate individual and systems factors affecting modest and sustained PE usage over time. Implications regarding sustained clinician behavior change will be discussed and evaluation and policy recommendations will be presented.


2. Dissemination and Implementation of Trauma-Informed, Evidence-Based Interventions: Testing the Community-Based Learning Collaborative Model in South Carolina.
Presentation Slides     Video of Presentation

Presenter:     Rochelle Hanson
Authors:     Rochelle Hanson, Ben Saunders, E. Ralson, Dee Norton Lowcountry Children’s Center, Michael de Arellano, Medical University of South Carolina, and Rachael Garrett, Dee Norton Low Country Children’s Center

Abstract:    This presentation provides an overview of Project BEST (Bringing Evidence-Supported Treatments to South Carolina children and families; funded by Duke Endowment), an ongoing statewide initiative designed to support the dissemination and implementation of Trauma-focused Cognitive Behavioral Therapy (TF-CBT). Phase 1 was a 3-year pilot to 1) test the Community-Based Learning Collaborative (CBLC) approach to dissemination, training, implementation, and sustained use of  TF-CBT; 2) test whether Children’s Advocacy Centers (CACs) were effective agents for building community capacity to deliver ESTs to abused children and their families; and 3) identify barriers and solutions to implementation. The CBLC approach trains clinicians to implement TF-CBT with fidelity, and brokers (non-clinical, child abuse professionals) on skills related to evidence-based treatment planning and case management. Overall, 266 professionals were involved in 4 different Project BEST learning collaboratives conducted in Phase I. Of these, 129 (48%) completed all training requirements. Clinicians conducted pre-treatment assessments on 337 registered training cases, and significant improvements were noted pre-post treatment (i.e., reduction in PTSD symptom severity, proportion of children with PTSD diagnosis, symptoms of depression, and improved parenting behaviors). The presentation includes a discussion of challenges encountered in this statewide initiative, lessons learned, and Phase 2 expansion and sustainability activities.


3. A Partnership Approach to Evaluation of the Implementation of a Natural Experiment
Presentation Slides       Video of Presentation

Presenter:    Leif Solberg
Authors:     Leif Solberg, HealthPartners Research Foundation, Jürgen Unützer, University of Washington, Nancy Jaeckels, Institute for Clinical Systems Improvement (ICSI), Lauren Crain, HealthPartners Research Foundation, Gary Oftedahl, Institute for Clinical Systems IMprovement (ICSI), and Arne Beck, Kaiser Permanente Colorado.

Introduction: If we want to understand the effects and implementation lessons that the many natural experiments in care redesign provide, we need to be in on their early stages and to design and conduct research or evaluation in collaboration with those who are leading the implementation.  This report describes such an example – a statewide initiative to implement an evidence-based care redesign for primary care of depression called DIAMOND

Methods: The Initiative involved all 7 state health plans providing a new payment for collaborative depression care to the 80 clinics that were trained and certified as able to provide it.  As it was being developed, a proposal to NIMH was submitted and funded in close partnership between researchers and implementers.  Key to a rigorous design was agreement to implement in five sequences over two years with all clinics identified at the start, so study subjects could be recruited continuously, providing multiple baselines that controlled for secular trends without requiring a formal control group.

Results: 27 months into the Initiative, the Study has recruited 2400 patients and surveyed 555 physician and nurse leaders (99.5% response rate) to understand impact and implementation.  It has also collected implementation and operating costs.