Developing and Implementing a Process Improvement Intervention to Expand Evidence-Based Psychotherapy in the Department of Defense

This article presents an overview of a novel process improvement project that aimed to enhance the utilization of prolonged exposure for treating posttraumatic stress disorder in behavioral health clinics within the Military Health System (MHS). The MHS is a geographically dispersed medical system encompassing diverse clinics and poses unique challenges to the adoption of evidence-based practices. To address these challenges, the Targeted Assessment and Context-Tailored Implementation of Change Strategies project was developed. Implemented across eight MHS clinics, this project involved conducting a comprehensive needs assessment to identify barriers, developing customized implementation plans for each site, and providing coaching calls and access to a clinic optimization toolkit for the clinic staff. We describe the development of Targeted Assessment and Context-Tailored Implementation of Change Strategies intervention components, including an implementation rubric that documents barriers to evidence-based practice utilization and proposes specific actions based on the underlying causes of these barriers. Additionally, a needs assessment interview tool and an implementation toolkit were developed to identify clinic-level challenges and support the implementation process, respectively. The needs assessment phase of the project involved conducting interviews with clinic staff and leadership, as well as reviewing clinic appointment data to discern trends and patterns in care. The insights gleaned from these interviews were instrumental in formulating tailored implementation plans for increasing the usage of prolonged exposure. Each plan was collaboratively developed with clinic leadership and subsequently put into practice at the site with the support of weekly coaching calls provided by an implementation science expert. Portions of this research project occurred during the COVID-19 pandemic, and we discuss the impact of the pandemic on the implementation of this study.