VA PTSD clinic director perspectives: How perceptions of readiness influence delivery of evidence-based PTSD treatment.

Despite extensive data from randomized controlled trials supporting the efficacy of evidence-based treatments (EBTs), the adoption of these interventions in the Department of Veterans Affairs (VA) and the Department of Defense has been markedly slow. Qualitative interviews were conducted with a nationally representative sample of 38 directors of specialized posttraumatic stress disorder outpatient programs in VA medical centers about implementation of two EBTs. Every director confirmed that EBTs, specifically prolonged exposure and cognitive processing therapy, were provided in their program. It was nearly universal, however, for these treatments to be preceded by preparatory groups. The consensus among directors was that these groups improve readiness for trauma-focused EBTs, help veterans to make informed decisions about their treatment plans, improve coping skills and symptom management, and decrease the likelihood of no-shows for scheduled EBTs. The concept of readiness for trauma-focused EBTs guided program development and flow throughout the programs. Implications for increased implementation of EBTs include developing and disseminating standardized ways of explaining their rationale and expected outcomes. Future research directions, such as empirically identifying veterans who are willing to participate in and benefit from these EBTs, are also noted.