Evaluation of a Pilot Implementation of Clinician Support for the PTSD Coach Mobile App in VA Primary Care Mental Health Integration Programs

Abstract

Objective: PTSD symptoms are common in primary care (PC) patients but often go untreated, as PC-based PTSD interventions are not widely available and many patients do not engage in PTSD treatment in specialty settings. Expanding implementation of evidence-based PTSD treatment in PC can increase treatment access. We conducted a program evaluation of a one-year pilot implementation program of a PC-based PTSD treatment that combines clinician support with a mobile app. Method: Thirty mental health clinicians embedded in PC from clinics across the Veterans Health Administration (VHA) were trained in Clinician-Supported (CS) PTSD Coach, then participated in community of practice calls. RE-AIM outcomes of reach, effectiveness, adoption, implementation, and maintenance were assessed via electronic medical record notes and provider surveys. Implementation barriers, enablers and adaptations were systematically tracked during implementation activities. Results: Reach: 871 CS PTSD Coach sessions were delivered to 348 patients. Effectiveness: Patients demonstrated improvement in PTSD severity (d = −0.37, p < .001). Adoption: 27 clinicians (90%) from 16 of 18 VHA geographic regions delivered CS PTSD Coach sessions. Implementation: Regarding intervention fidelity, 77–87% of the essential elements were delivered. Maintenance: 20 clinicians (71%) continued using CS PTSD Coach after active implementation support. Conclusions: The training and implementation support program resulted in strong uptake of CS PTSD Coach, with adherent and effective delivery. The program structure and identified solutions to implementation challenges can inform future large-scale efforts to implement interventions that incorporate mobile apps to help address the needs of trauma survivors.