Evidence Based Psychotherapies in the VA Claire Collie, Ph.D. Local Evidence Based Psychotherapy Coordinator Durham VAMC

With Thanks to Dr. Brad Karlin Associate Chief Consultant for Psychotherapy and Psychogeriatrics Office of Mental Health Services

VHA Mental Health Strategic Plan Implemented in 2005 resulting from the President’s New Freedom Commission Final Report 265 Recommendations including Capacity, access, elimination of disparities Implementation of evidence-based practices

Uniform MH Services Handbook (UMHSH) Directives include implementation of EBPs and specifies that all Veterans must have access to EBPs Names specific EBPs for particular disorders (e.g., CPT and PE for PTSD) Specifies minimum requirements for ensuring access to a core set of evidence based psychotherapy services

UMHSH and EBPs Facilities may provide additional EBPs and other psychosocial services, and non-EBPs may be offered when appropriate (e.g., no EBP exists for a particular condition or a veteran expresses specific preference for other approaches) All patients with PTSD, Depression, or SMI should be offered the option of receiving EBPs for these conditions and have the opportunity to discuss the therapy (or therapies) and how they may be helpful to the patient’s specific problems. The decision as to which particular treatment a patient receives should be made collaboratively by the therapist and the informed patient.

Why Is VA Promoting Use of EBPs? EBPs are an opportunity to take advantage of the advancements from science and research about many MH conditions and to make these evidence-based and highly effective treatments available to all Veterans EBPs are effective and will increase VA’s capacity to provide top-quality care to even more veterans EBPs reduce staff burnout

Why Is VA Promoting Use of EBPs? EBPs are consistent with a recovery model EBPs are consistent with VA’s mission to provide “The Best Care Anywhere” Providing high quality psychotherapy will increase the value placed on psychotherapy in general within VA (vs. medication and case management only)

Promoting EBPs Within VA VA Central Office now has an EBP Initiative Local Evidence Based Psychotherapy Coordinators ◦ Serve as local EBP consultant and champion ◦ Assist with efforts to implement EBPs at the local level and ensure compliance with VA directives regarding EBPs ◦ Assist with local monitoring of implementation and outcomes ◦ Act as liaison between Medical Center Clinical Staff and Administration (Medical Center, Regional, and Central Office)

Promoting EBPs Within VA National Dissemination Initiatives for each EBP being rolled out in VA ◦ Administrative staff oversee training policies and operations and conduct ongoing monitoring and evaluation of dissemination efforts ◦ Trainers and consultants conduct training workshops and provide consultation ◦ Dissemination Initiative staff are available as resources to Local EBP Coordinators and VA clinicians

National Initiatives to Train VA MH Clinicians in EBPs PTSD ◦ Prolonged Exposure Therapy (PE) ◦ Cognitive Processing Therapy (CPT) Depression ◦ Cognitive Behavioral Therapy (CBT) ◦ Acceptance and Commitment Therapy (ACT)

National Initiatives to Train VA MH Clinicians in EBPs SMI ◦ Social Skills Training (SST) ◦ Behavioral Family Therapy (BFT) ◦ Multi Family Group Therapy (MFGT) Marital Distress ◦ Integrated Behavioral Couples Therapy (IBCT) Insomnia ◦ Cognitive Behavioral Therapy For Insomnia (CBT-I)

National Initiatives to Train VA MH Clinicians in EBPs Problem Solving Training (PST) Motivational Interviewing (MI) Substance Use Disorders ◦ Contingency Management (CM) ◦ Motivation Enhancement Therapy (MET)

Training Model In-person, experientially-based workshop (2 – 4 days) Ongoing, weekly consultation to build mastery and facilitate implementation (including tape review) Informal consultation opportunities over the longer- term (e.g., Local Evidence Based Psychotherapy Coordinators) MH providers from four core MH disciplines eligible to participate (Psychology, Social Work, Psychiatry, and Nurse Practitioners) ◦ Social Skills Training and Problem Solving Training have been designed for a broader audience

Monitoring and Evaluation of Implementation of EBPs Survey of facilities re: staff capacity and patient utilization Administrative data analysis Computerized EBP progress note templates Evaluation of training programs and impact

New Developments Decentralized training processes being developed to increase dissemination and promote sustainability (e.g., training additional Regional consultants and trainers) Dissemination of additional EBPs are being planned for the future (e.g., IPT for Depression, CBT for SUD)

Questions?