The Center for Deployment Psychology’s Clinic Optimization Program (COP) is the culmination of efforts under two prior research efforts: the Joint Incentive Fund #9 Decentralized Evidence-Based Psychotherapies (EBPs) Mental Health Provider Training and Consultation to Improve Quality and Access to Care (JIF-9) project, and the Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS).
JIF-9 Program:
Background:
The JIF-9 program (2013-2017) was a Department of Veterans Affairs (VA)/Department of Defense (DoD) joint funded program to address Integrated Mental Health Strategies Strategic Aim #9: to develop a system to deliver evidence-based psychotherapies. To accomplish this aim, the JIF-9 program modeled the VA’s decentralized training and consultation model at ten pilot military treatment facilities throughout the DoD.
CDP hired Champion-Consultants at each location to broaden dissemination and promote sustainability of EBPs. The initiative focused primarily on providing training and consultation in applying two types of EBPs for Posttraumatic Stress Disorder (PTSD): Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT). Although the primary focus of this initiative was on EBPs for PTSD, the ultimate goal was to develop a system that would serve as a model and provide the infrastructure for future cross-departmental collaboration with respect to other EBPs.
To accomplish these goals, CDP provided training in PE and/or CPT to each of the ten sites. Champion-Consultants identified providers to receive consultation and to train as consultants. Throughout the JIF-9 project, 171 unique DoD providers received consultation in either PE or CPT from the onsite Champion-Consultants. In addition, 28 providers completed a Train-the-Consultant workshop in either PE or CPT, and 11 of those completed requirements to be consultants at their sites, enabling them to continue offering consultation to fellow providers after the program ended.
The Champion-Consultants also worked with clinic leadership to identify local barriers to implementation of EBPs and come up with strategies and tools to address them. These barriers and potential solutions are detailed in the Lessons Learned Manual (see below). Initial drafts of many of the COP toolkit items were developed by the Champion-Consultants as they worked to increase EBP use at their sites.
Publications & Presentations:
Center for Deployment Psychology. (2015). Lessons Learned Manual: A Framework for Addressing
Barriers to Evidence-Based Psychotherapy Utilization in the Defense Department. Center for
Deployment Psychology: https://deploymentpsych.org/system/files/member_resource/FINAL_Lessons_Learned_Manual_Aug16.pdf
TACTICS Program:
Background:
The TACTICS program (2017-2023) is a Congressionally Directed Medical Research Programs (CDMRP) funded multi-site research collaboration between the Palo Alto Veterans Institute for Research (PAVIR), the Palo Alto VA/Stanford University, CDP, the South Texas Research Organization Network Guiding Studies on Trauma And Resilience (STRONGSTAR), the University of Washington, the University of Texas-Austin, and Social Sciences Innovation Corp (SSIC).
The goal of the research study was to expand the use of PE for the treatment of PTSD at eight participating MTF behavioral health clinics by partnering with clinic staff to address barriers to use at the local level. Previous work with the JIF-9 program allowed CDP to catalog numerous barriers to implementation of EBPs, at the provider, clinic and patient level, and develop a set of recommendations to mitigate these barriers.
To prepare the sites for the TACTICS intervention, CDP delivered PE training at each site and offered weekly consultation via phone or Zoom and additional online training opportunities through the intervention and follow-up periods. Each site was randomized to begin the TACTICS intervention in a stepped wedge cohort design. An in-depth description of the study design (Rosen et al., 2020) is available (see Publications & Presentations below).
The TACTICS intervention began with a focused needs assessment to identify barriers to PE use followed by the development of a customized implementation plan to address barriers, and finally weekly coaching to implement this plan. An analysis of the barriers identified across sites (McLean et al., 2022) is also available (see Publications & Presentations below). As part of their weekly coaching, site coaches also provided access to COP toolkit items designed for DoD clinics to optimize services, including expanding the use of EBPs.
Archival data collection is still ongoing and additional results will be disseminated upon completion. A current listing of the publications and presentations from the TACTICS program are found below.
Publications & Presentations:
McLean, C. P., Cook, J., Riggs, D. S., Peterson, A. L., Young-McCaughan, S., Borah, E. V., Comtois, K.
A., Dondanville, K. A., Frick, E., Haddock, C. K., Mann, J., Reynolds, D., Mistretta, M., Neitzer, A.,
Brzuchalski, A., Clayton, S. P., Conforte, A. M., DuMars, T. D., Ekundayo, K., Flores, A., Hein, J.,
Jinkerson, J., Keith, F., Kim, H., J., Letendre, M., Link, J. S., Nofziger, D., Pollick, K., Ringdahl, E. M.,
Steggles, S. J., Waggoner, J., Woodworth, C., & Rosen, C. S. (2022). Barriers and Potential
Solutions to Implementing Evidence-Based PTSD Treatment in Military Treatment Facilities.
Military Medicine. https://doi.org/10.1093/milmed/usac240
Rosen, C. S., Davis, C. A., Riggs, D., Cook, J., Peterson, A. L., Young-McCaughan, S., Comtois, K. A.,
Haddock, C. K., Borah, E. V., Dondanville, K. A., Finley, E. P., Jahnke, S. A., Poston, W. S. C.,
Wiltsey-Stirman, S., Neitzer, A., Broussard, R., Brzuchalski, A., Clayton, S. P., Conforte, A. M.,
Flores, A., Hein, J., Keith, F., Jinkerson, J., Letendre, M., Nofziger, D., Pollick, K., Santiago, K.,
Waggoner, J., Woodworth, C., & McLean, C. P., for the STRONG STAR Consortium and the
TACTICS Research Group. (2020). Targeted assessment and context-tailored implementation of
change strategies (TACTICS) to increase evidence-based psychotherapy in military behavioral
health clinics: Design of a cluster-randomized stepped-wedge implementation study.
Contemporary Clinical Trials, 93, 106008. https://doi.org/10.1016/j.cct.2020.106008
Rosen, C., Davis, A., McLean, C., Peterson, A., Young-McCaughan, S., Haddock, K., Neitzer, A.,
Wiltsey-Stirman, S., Mallard, K., Mackintosh, M., McGee-Vincent, P., Riggs, D., Cook, J., Mistretta,
M., Brim, W., French, L., Phillips, J., Frick, E., Mann, J., Mir, R., Milochik, A., Dondanville, K.,
Finley, F., Hargita, D., Poston, C., Jahnke, S., Comtois, K. Pierson, A., Hendricks, K., Crow, B.,
McInerney, S., Borah, E. (2018). Cross-walking implementation theory and practice: Applying
practical knowledge, CFIR and ERIC frameworks to implementing evidence-based psychotherapy
in the U.S. Dept. of Defense. 11th Annual Conference on the Science of Dissemination and
Implementation in Health, Washington, DC.
Rosen, C., Riggs, D., Peterson, A., Young-McCaughan, S., Borah, E., Brim, W., Comtois, K., Cook, J.,
Davis, A., Dondanville, K., Finley, E., Hancock, A., Mackintosh, M., Neitzer, A., Wiltsey-Stirman, S.,
McLean, C. P. (2018). Targeted Assessment and Context-Tailored Implementation of Change
Strategies (TACTICS) to Increase EBP Use in U.S. Military Treatment Facilities. 34th Annual
Meeting of the International Society for Traumatic Stress Studies, Washington, DC.