• Carmen P McLean, Jeffrey Cook, David S Riggs, Alan L Peterson, Stacey Young-McCaughan, Elisa V Borah, Katherine Anne Comtois, Katherine A Dondanville, Erin Frick, Christopher K Haddock, Jeffrey Mann, David Reynolds, Melissa Mistretta, Andrea Neitzer, Amy Brzuchalski, Spencer P Clayton, Allison M Conforte, Tyler D DuMars, Kendra Ekundayo, Araceli Flores, Jessica Hein, Jeremy Jinkerson, Felicia Keith, Hana J Kim, Jared S Link, Debra Nofziger, Kirsten Pollick, Erik N Ringdahl, John Waggoner, Craig Woodworth, and Craig S Rosen.
• National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA.
• Mil Med. 2024 Feb 27; 189 (3-4): 721731721-731.

IntroductionProlonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers.Materials And MethodsAs part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators, barriers, and potential solutions were summarized in a collaboratively developed implementation plan for increasing prolonged exposure therapy tailored to each site.ResultsThere was a greater than anticipated consistency in the barriers reported by the sites, despite variation in the size and type of facility. The identified barriers were grouped into four categories: time-related barriers, provider-related barriers, barriers related to patient education and matching patients to providers, and scheduling-related barriers. Potential solutions to each barrier are described.ConclusionsThe findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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