Using predictive models of behavior change to promote evidence-based treatment for PTSD.

Abstract

While there is a strong evidence base regarding effective treatment of Posttraumatic Stress Disorder (PTSD), and an increased number of treatment guidelines available internationally, research indicates that there is significant variation in clinical practice. This study aimed to identify effective ways to promote adoption of trauma-focused interventions in community services offering mental health care to people who have experienced trauma. The study sought to do so by identifying factors influencing the uptake of evidence-based practice at both an individual and organizational level, and trialing competency training and support strategies based on these factors across 6 community trauma services. The effectiveness of the training and support strategies was investigated using self-report surveys and prospective recording of clinicians' treatment planning for PTSD clients. The study found that while lack of skills and confidence were identified as significant barriers to the uptake of trauma-focused interventions, expectations about treatment outcomes and organizational factors also influenced clinical behavior. This finding highlighted the importance of considering factors other than knowledge and skills when developing training and other interventions to support the implementation of evidence-based practice. Furthermore, it was found that a training and implementation process tailored to organizational and individual barriers, and based on currently recognized theories of behavior change, led to a significant increase in the use of imaginal exposure in the treatment plans of clients assessed as having PTSD. This change was maintained 6 months following training. © 2011 American Psychological Association.