Barriers and Potential Solutions to Implementing Evidence-Based PTSD Treatment in Military Treatment Facilities.

INTRODUCTION: Prolonged 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 METHODS: As 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. RESULTS: There 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. CONCLUSIONS: The 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.

Validation of grooved pegboard cutoffs as an additional embedded measure of performance validity.

OBJECTIVE: Using embedded performance validity (PVT) comparisons, Erdodi et al. suggested that Grooved Pegboard (GPB) T-score cutoffs for either hand (≤ 29) or both hands (≤ 31) could be used as additional embedded PVTs. The current study evaluated the relationship between these proposed cutoff scores and established PVTs (Medical Symptom Validity Test [MSVT]; Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). METHOD: Participants (N = 178) were predominately Caucasian (84%) males (79%) with a mean age and education of 41 (SD = 11.7) and 15.8 years (SD = 2.3), respectively. Participants were stratified as "passing" or "failing" the GPBviaErdodi's proposed criteria. "Failures" on the MSVT, NV-MSVT, and RDS were based on conventional recommendations. RESULTS: Moderate correlations between GPB classification and a condition of interest (COI; i.e. at least two failures on reference PVTs) were observed for dominant (χ2 (1, n = 178) = 34.72, ϕ = .44, p < .001), non-dominant (χ2 (1, n = 178) = 16.46, ϕ = .30, p = .001), and both hand conditions (χ2 (1, n = 178) = 32.48, ϕ = .43, p < .001). Sensitivity, specificity, and predictive power were generally higher than Erdodi et al.'s initial findings. CONCLUSION: These findingsprovide supportfor the clinical utility of the GPB as an additional embedded PVT. More specifically, dominant and both hand cutoffs were found to be more robust measures ofnon-genuine performance in those without motor deficits. While promising, sensitivity continues to be low; therefore, it is ill-advised to use the GPB as a sole measure of -performance validity.

ACTing Like a Psychiatrist.

Acceptance and commitment therapy (ACT), a form of cognitive behavioral therapy, predominately focuses on addressing one's relationship with thoughts and emotions rather than attempting to alter them. The use of ACT has demonstrated efficacy in interactions with patients suffering from a variety of mental health concerns. While there are no specific criteria for the use of ACT, one compelling argument that exists in support of its use is that ACT may be more efficacious than other control-based protocols in treating experiential avoidance. Further, there is some evidence available to suggest that ACT is more effective than other active treatments for depression. Here, the six core processes of ACT therapy are discussed and the application of ACT techniques in clinical practice is explored.

Clinical utility and characteristics of the brown location test for individuals with right temporal lobe epilepsy.

This Rehabilitation Measures Database summary provides a review of the characteristics of the BLT for individuals with right temporal lobe epilepsy. A full review of the BLT as well as reviews of over 300 other instruments can be found at www.rehabmeasures.org. (PsycINFO Database Record