Expanding Evidence Based Psychotherapy (EBP) Utilization

Expanding the use of EBPs will convey numerous benefits to a clinic, for patients, providers and the clinic as a whole. Patients who have access to EBPs for their disorders should have an improved chance to recover, and for active-duty members, that translates to lower chances for separation from the military. DoD mandates that service members have access to these kinds of state-of-the-art therapies because they are proven to be effective for the target conditions. When patients receive an EBP, they should recover faster than other patients who receive supportive counselling, translating into fewer sessions per patient and more capacity.

The Increasing EBP Utilization training deck gives an overview on best practices for increasing the amount of EBP utilization in a clinic and is an excellent starting point and reference for clinic leaders.

There are a number of actions that clinic leaders can take that will increase the usage of evidence-based psychotherapies within their clinic, which include things like strongly endorsing EBP use, providing incentives for EBP use, and changing how charts are rated during peer review. Another key area is to address gaps in training or confidence with using EBPs for common conditions.

Clinic leadership should strongly endorse EBPs for common conditions like Depression, Anxiety and Insomnia. Clinic leaders can send a strong message of support for EBP use within a clinic, by messaging the importance of EBPs in meetings, becoming one of the EBP users themselves, and many other actions. This content is covered in the EBP Utilization Training Deck, which reviews best practices for shifting more of the care within a clinic over to EBPs. The Best Practices in Documenting EBPs training deck gives an overview of using note templates for EBPs. The Introduction to EBPs training deck is designed to be delivered to clinic providers and provides an overview of EBPs for common conditions, including the many benefits of using EBPs, which will hopefully help increase provider willingness to use EBPs with their patients. In addition to encouraging the use of EBPs verbally, there are other concrete steps leaders can employ to increase use of EBPs:

• Address lack of training in EBPs. A key barrier to using EBPs within clinics is a lack of training in the relevant EBPs. DoD clinic leaders can have their providers visit CDP’s page to sign up for EBP workshops. Providers who have had a training in the past can attend a workshop a second time as a refresher.
• Explore incentives to use EBPs in routine practice. Another means of increasing use is to incentivize providers to use EBPs. The toolkit has ideas for this in the handout Provider Incentives for Evidence-Based Psychotherapy Use . There is also a sample template Letter of Appreciation for Employees Delivering EBPs, which you can use to provide formal recognition for employees.
• Modify peer review forms to ask about EBP use for certain disorders (e.g., MDD, PTSD). A clinic can also encourage greater use of EBPs for common conditions by modifying the language/criteria of its peer review form to include references to EBP use. The SOP/OI Peer Review in Support of EBPs provides a template for establishing a clinic policy to do this, while the Monthly Peer Review: EBP Addendum provides sample language for including in the peer review.
• Educate providers about correct misinformation about EBPs. Some providers are theoretically resistant to EBPs or hold misconceptions that make them resistant to using EBPs. For example, many providers who have doubts about exposure-based treatments such as PE. In these cases, it may be helpful to attempt to convince them that the treatment is safe and effective by reviewing the results of research literature on EBPs. The toolkit contains many factsheets and handouts such as: PE Provider Factsheet , Prolonged Exposure FAQs: Patient Appropriateness , Myths about Exposure Therapy (Provider) and even an Introduction to EBPs Training Deck that was designed to highlight the benefits of EBPs in clinical practice.

Optimize routing of patients to EBP trained providers: If you have a shortage of providers in your clinic trained to treat conditions like MDD or PTSD, or if some providers just aren’t comfortable with learning to use EBPs for conditions like PTSD, you might consider changing the way that patients are routed to providers, to ensure that cases with conditions such as PTSD cases are matched to EBP providers. In order to start to match patients to EBP trained providers, you will need to:

• Identify cases before intake if possible. Ideally, you will want to identify cases early and route them to EBP trained providers before intake. Tools that describe best practices for screening referrals are covered in the Managing Patient Throughput page.
• Maintain a list of EBP trained providers. You can rapidly get a sense of what EBPs your providers have already been trained in and are familiar with using, by using a set of toolkit items described under the Gap Analysis page (e.g., EBP Training & Utilization Provider Questionnaire).
• Make it easier to transfer cases after intake to other providers who provide the EBP. Change local policy to make it easier to transfer a case after intake if the intake provider does not use an EBP for the patient’s condition. These and other ideas for handling matching cases to EBP providers are covered in the Managing Patient Throughput page.
• Consider setting up a sub-clinic. Another means of managing this issue it to establish a sub-clinic for certain diagnoses, where a subset of providers treats most cases with that diagnosis. This concept and associated tools are covered in the Managing Patient Throughput page.

Relevant toolkit items: