Employing a Stepped-Wedge Design to Implement an Evidence-Based Psychotherapy for PTSD in Six Large, Diverse Health Care Systems

Grant Details

Funder: PCORI

Grant Number:

Project Period: 2022 – 2025

  • Lead Sites:
    • Yale (co-PI Joan Cook) and KPHI (co-PI Vanessa Simiola)
  • Participating Sites:
    • Henry Ford Health System (co-I Lisa Matero)
    • Kaiser Permanente Northwest (co-I Frances Lynch)
    • Kaiser Permanente Georgia (co-Is Ashli Owne-Smith, Kanetha Wilson, Courtney McCracken)
    • Essentia Health (co-I Melissa Harry)
    • Baylor Scott & White Health (co-I Katherine Sanchez)

Brief Narrative: Written Exposure Therapy (WET) is a five-session exposure-based EBP for PTSD that was efficacious in randomized controlled trials for treating PTSD from different types of traumas. In addition to PCORI’s recognition, WET is recommended as a first-line treatment by the Department of Veteran Affairs (VA) and the Department of Defense (DoD). In two recent trials, WET was non-inferior to the more time-intensive, gold-standard EBP, Cognitive Processing Therapy. Thus, WET seems to meet the need for alternative PTSD treatments that are brief, with little dropout, and require less clinical training. Indeed, WET’s brevity and tolerability make it an ideal first-level intervention, appealing to patients who have opted not to seek out more time- and therapist-intensive EBPs. WET addresses significant barriers to other EBPs for PTSD at the patient, provider, and system levels.

The project will employ a stepped wedge design to implement WET in six, large, diverse, integrated, civilian health care systems across the United States— Kaiser Permanente (KP) Hawaii, Henry Ford Health System, Kaiser Permanente Northwest, Kaiser Permanente Georgia, Essentia Health, and Baylor Scott & White Health — with all sites receiving the intervention during the project period. The healthcare systems are members of the Mental Health Research Network (MHRN), a consortium of 14 research centers. Sites will be assigned to one of two implementation groups. Every site will receive WET training, consultation, and multi-component implementation strategies, promoting equity and advancing the field of implementation science.

The specific aims of this project are to:

  1. Employ multi-component implementation strategies to help mental health providers implement WET for their PTSD patients in mental health settings in six health care systems.
  2. Use Consolidated Framework for Implementation Research (CFIR) to understand the determinants and process of implementation.
  3. Utilize RE-AIM framework to evaluate implementation outcomes for mental health providers and patients.