Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach

Background A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. Objective The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. Methods An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Results Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. Conclusions The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.

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Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach (Preprint)

10.2196/preprints.10277 ◽

2018 ◽

Author(s):

Traci H Abraham ◽

Kathy Marchant-Miros ◽

Michael B McCarther ◽

Michelle G Craske ◽

Geoffrey M Curran ◽

...

Keyword(s):

Mental Health ◽

Veterans Affairs ◽

Outpatient Clinics ◽

Evidence Based ◽

Mental Health Providers ◽

Health Providers ◽

Focus Group Discussions ◽

Group Discussions ◽

Community Based ◽

Computer Based

BACKGROUND A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. OBJECTIVE The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. METHODS An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. RESULTS Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. CONCLUSIONS The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.

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Factors affecting the implementation of evidence-based Progressive Tinnitus Management in Department of Veterans Affairs Medical Centers

PLoS ONE ◽

10.1371/journal.pone.0242007 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242007

Author(s):

Tara L. Zaugg ◽

Emily J. Thielman ◽

Kathleen F. Carlson ◽

Anaïs Tuepker ◽

Christine Elnitsky ◽

...

Keyword(s):

Mental Health ◽

Program Implementation ◽

Veterans Affairs ◽

Stepped Care ◽

Evidence Based ◽

Mental Health Providers ◽

Department Of Veterans Affairs ◽

Health Providers ◽

Factors Affecting ◽

Factors Influencing

Purpose Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of PTM program implementation in VA Audiology and Mental Health clinics across the country; and 2) identify barriers and facilitators to PTM implementation based on the experiences of VA audiologists and mental health providers. Method We conducted an anonymous, web-based survey targeting Audiology and Mental Health leaders at 144 major VA facilities. Quantitative analyses summarized respondents’ facility characteristics and levels of program implementation (full PTM, partial PTM, or no PTM). Qualitative analyses identified themes in factors influencing the implementation of PTM across VA sites. Results Surveys from 87 audiologists and 66 mental health clinicians revealed that few facilities offered full PTM; the majority offered partial or no PTM. Inductive analysis of the open-ended survey responses identified seven factors influencing implementation of PTM: 1) available resources, 2) service collaboration, 3) prioritization, 4) Veterans’ preferences and needs, 5) clinician training, 6) awareness of (evidence-based) options, and 7) perceptions of scope of practice. Conclusion Results suggest wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training. Future research should address barriers to PTM implementation, including methods to: 1) improve understanding among mental health providers of their potential role in tinnitus management; 2) enhance coordination of tinnitus-related care between health care disciplines; and 3) collect empirical data on Veterans’ need for and interest in PTM, including delivery by telehealth modalities.

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The Emergency Assessment and Management of Non-Suicidal Self-Injury in Adolescents

Adolescent Psychiatry ◽

10.2174/2210676609666190618162558 ◽

2020 ◽

Vol 9 (2) ◽

pp. 92-99

Author(s):

Sindhu A. Idicula ◽

Amy Vyas ◽

Nicole Garber

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Outpatient Clinics ◽

Psychiatric Diagnoses ◽

Mental Health Providers ◽

Health Providers ◽

Levels Of Care ◽

Self Injury ◽

History Of ◽

Inpatient Units

Background and Goals: Non-suicidal self-injury (NSSI) is a common presenting issue mental health providers experience in all levels of care from outpatient clinics to inpatient units. It is common among adolescents seen in emergency settings, either as a presenting problem or as a covert condition that may not be detected unless specifically assessed for. The presence of NSSI increases the risk of suicide. This article aims to help the clinician develop a better understanding of NSSI – what it may entail, the prevalence, and the motivations for why young people engage in it. Methods: We review the reasons adolescents injure themselves, the link between NSSI and psychiatric diagnoses and suicide, the assessment of NSSI, and treatment planning, with emphasis on ways to screen for NSSI and interventions that can be implemented in the Emergency Department. We illustrate the complexity of NSSI with the case of a young patient with a complex psychiatric history and an extensive history of self-injury. Results and Discussion: Despite the seeming intractability of NSSI, a number of evidencebased treatments exist. Treatment primarily involves specialized forms of psychotherapy, but interventions can be implemented in the ED that will reduce the immediate risk of NSSI while more definitive intervention is awaited. Conclusion: Mental health consultations in the ED should always include screening for NSSI. Mental health professionals in the ED can play an important role in the detection and treatment of this condition..

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RELATIONSHIP OF EVIDENCE-BASED PRACTICE AND TREATMENTS: A SURVEY OF COMMUNITY MENTAL HEALTH PROVIDERS

Journal of Community Psychology ◽

10.1002/jcop.20516 ◽

2012 ◽

Vol 40 (3) ◽

pp. 341-357 ◽

Cited By ~ 8

Author(s):

Michelle A. DiMeo ◽

G. Kurt Moore ◽

Carolyn Lichtenstein

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Evidence Based Practice ◽

Evidence Based ◽

Mental Health Providers ◽

Health Providers ◽

Relationship Of

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Access to Mental Health Services at Veterans Affairs Community-Based Outpatient Clinics

Military Medicine ◽

10.1093/milmed/167.5.424 ◽

2002 ◽

Vol 167 (5) ◽

pp. 424-426 ◽

Cited By ~ 3

Author(s):

Adam F. Wooten

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Veterans Affairs ◽

Outpatient Clinics ◽

Community Based

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Perspectives of Veterans Affairs mental health providers on working with older adults with dementia and their caregivers

Gerontology & Geriatrics Education ◽

10.1080/02701960.2020.1764356 ◽

2020 ◽

pp. 1-12

Author(s):

Mary F. Wyman ◽

Corrine I. Voils ◽

Ranak Trivedi ◽

Lisa Boyle ◽

Daniel Goldman ◽

...

Keyword(s):

Mental Health ◽

Older Adults ◽

Veterans Affairs ◽

Mental Health Providers ◽

Health Providers

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The Limitations and Strengths of the Evidence-Based Practice Attitude Scale as a Measure of Correctional Employees’ Attitudes: A Psychometric Evaluation

International Journal of Offender Therapy and Comparative Criminology ◽

10.1177/0306624x17749450 ◽

2017 ◽

Vol 62 (12) ◽

pp. 3947-3964 ◽

Cited By ~ 2

Author(s):

Breanna Boppre ◽

Jody Sundt ◽

Emily J. Salisbury

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Evidence Based Practice ◽

Psychometric Evaluation ◽

Attitude Scale ◽

Evidence Based ◽

Correctional Staff ◽

Mental Health Providers ◽

Health Providers ◽

Evidence Based Practices

Evidence-based practices (EBPs) hold tremendous potential for improving the outcomes of corrections interventions. The implementation of EBPs requires support from staff at all levels of an organization; however, the study of correctional staff attitudes toward organizational change and EBPs is in its infancy. The current study examines the psychometric properties of the Evidence-Based Practice Attitude Scale (EBPAS), an instrument originally designed for mental health professionals, to measure correctional employees’ readiness to implement EBPs. The results indicate mixed conclusions regarding the use of the EBPAS with correctional staff. We found that the total scale and subscales are reliable and exhibit high internal consistency. However, the results of an exploratory and confirmatory factor analysis failed to replicate the factor structure from previous research with mental health providers. The findings indicate potential drawbacks regarding the construct validity of the EBPAS for use with correctional personnel.

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