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Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study
Michael R Kauth1, Greer Sullivan, Dean Blevins
1South Central Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Fort Roots Drive, Little Rock, AR, USA. michael.kauth@va.gov.
Implementation Science : IS
|October 15, 2010
Summary
External facilitation significantly increased cognitive behavioral therapy (CBT) use in Department of Veteran Affairs clinics. This strategy offers a cost-effective method for implementing complex mental health treatments.
Area of Science:
- Implementation Science
- Mental Health Services Research
- Healthcare Management
Background:
- Healthcare systems struggle to implement evidence-based mental health treatments like psychotherapy.
- External facilitation shows promise as a strategy for adopting complex practices in healthcare.
Purpose of the Study:
- To pilot the use of external facilitation for increasing the adoption of cognitive behavioral therapy (CBT) in Department of Veteran Affairs (VA) clinics.
- To compare CBT implementation in clinics receiving external facilitation versus those that did not.
Main Methods:
- 20 VA clinics were paired; 23 clinicians trained in CBT.
- One clinic per pair received external facilitation; the other served as a control.
- Quantitative and qualitative methods assessed CBT use, provider characteristics, costs, and contextual factors.
Main Results:
- Facilitated therapists increased self-reported CBT use by 19%, compared to 4% in controls.
- Therapists new to CBT showed the largest increase (35%) in the facilitated group.
- Barriers included lack of schedule control and poor communication with leaders.
Conclusions:
- External facilitation can aid clinicians in adopting complex practices like evidence-based psychotherapy.
- Facilitation led to a substantial increase in CBT usage at a modest cost.
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