Redesigning trauma-focused interventions to address capacity challenges in mental health systems

Despite strong evidence supporting the use of trauma-focused evidence-based psychotherapies (EBPs) to treat posttraumatic stress disorder (PTSD), health care systems experience meaningful challenges in delivering these treatments at scale. With a focus on two large, integrated health care systems (Military Health System, Veterans Health Administration), we discuss the challenges to scaling up access to EBPs for PTSD, as well as proposed strategies to mitigate these challenges. We identify three primary barriers to delivery of EBPs for PTSD: insufficient staffing, difficulty connecting patients with EBP-trained providers, and structural inefficiencies characteristic of the weekly therapy model. We review emerging strategies to redesign the delivery of EBPs for PTSD, including accelerated delivery formats, alternative delivery settings, task-sharing, web- and app-based interventions, and the use of artificial intelligence. Taken together, these strategies represent promising opportunities to efficiently use limited staffing to increase access to EBPs for PTSD, while retaining or increasing intervention effectiveness. Further research is needed to determine how to most effectively integrate these strategies into a stepped-care model of treatment delivery, where redesigned approaches complement traditional EBP delivery models to address the real-world constraints of health care systems.