March 2016, the Defense Health Agency (DHA) Mental Health Work Group (MHWG) endorsed the recommendation to sustain the PBI Network across the DoD enterprise, with PHCoE retaining operational responsibility. The VA has also committed to sustain the PBI Network via the National Center for PTSD.

November 2016, PHCoE hosted the first annual Psychological Health Practice Change Prioritization Work Group (PCPWG) to review and prioritize practice change proposals for recommendation to the MHWG.

The PCPWG is made up of Implementation Science subject matter experts from: DoD, VA, Military Research and Materiel Command (MRMC), Walter Reed Army Institute of Research (WRAIR), National Intrepid Center of Excellence (NICoE), Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ), Center for Deployment Psychology (CDP), and Uniformed Services University of the Health Sciences (USUHS).

The PCPWG reviewed three proposals and provided feedback to the MHWG. The MHWG then selected Tech into Care (TIC) as the 2017 pilot project.

December 2017 the Second Annual PCPWG convened at PHCoE to reviewed and prioritized practice change proposals for recommendation to the MHWG.

February 2018 the MHWG selected the proposal focused on Cognitive Processing Therapy-trained Trauma Specialist as the 2018 pilot project.

Summer 2018 a Psychological Health Provider Needs and Preferences Survey will collect Service specific clinician feedback related to prioritization of research initiatives to inform the 2018 PCPWG.

1. Deploy and implement the PBI Network clinical and operational support, infrastructure and IT platform on an ongoing basis.

2. Deploy the PBI Network to test the speed of its translation efforts, and effectiveness of its model and structure through piloting use of the Posttraumatic Stress Disorder Checklist to monitor PTSD treatment outcomes

3. Implement the sustainment plan to institutionalize the PBI Network to facilitate practice change in the VA and DoD

The DoD and VA Practice-Based Implementation Network: Facilitating the Rapid Translation of Psychological Health Research

into Clinical Practice in the Military Health SystemHouston, J., McGraw, K.

Psychological Health Center of Excellence, Defense Health Agency (Research and Development-J9), Silver Spring, MD.

BACKGROUND, PURPOSE AND MODEL

The views expressed in this presentation are those of the authors and do not necessarily represent the official policy or position of the Psychological Health Center of Excellence, Department of Defense, Department of Veterans Affairs , United States Public Health Service or any other organization public or private. PUID 4821. UNCLASSIFIED

PILOTSINITIAL PTSD CHECKLIST PILOT PROJECT• The PBI Network implemented practice change initiatives at 12 behavioral health (BH) clinics

and two primary care (PC) clinics in the DoD Military Health System (MHS), and at 18 VA BH and PC clinics.

• The PBI Network used the PCL to monitor PTSD treatment outcomes in BH clinics as a pilot to test and evaluate PBI Network effectiveness.

Findings:• Results showed significantly increased PTSD outcomes monitoring by providers in outpatient

settings six months after PBI Network training and facilitation ended. • The PBI Network is a viable medium to facilitate clinical practice changes.• The PBI Network enhances enterprise operations because it is an enduring structure, thus

increasing efficiency of future practice changes using existing implementation trained clinicians.

TECH INTO CARE (TIC) AS THE 2017 PILOT PROJECT • The TIC Pilot aims to develop an implementation program that assists behavioral health

providers in the military health system with integrating and using mobile applications in clinical care.

• In person trainings completed at 3 Navy Sites, 4 Air Force sites in August and September 2017.

Findings: • Provider and patients are interested in opportunities to integrate technology into practice.

Mobile apps offer increased accessibility to treatment and support attainment of treatment goals.

• Variability in provider experience, needs and interest, and the unique demands and context of each military treatment facility requires a need for a multi-modal approach to integrating technology into practice.

• Access to adequate resources significantly impacts providers’ ability to introduce technology during their sessions.

GOALS

PBI NETWORK HISTORY AND STATUS

LESSONS LEARNED• Time constraints impacts adoption of practice change efforts. Time is one of the most

significant barriers to providers’ engagement. Possible solutions – dedicated staff for participation in implementation efforts modifying

clinic templates, protected time for participation, temporarily reducing relative value unit requirements.

• Objective measurement of provider behavior change is critical to evaluation of implementation effort.

While potentially challenging to obtain, objectively tracking provider behaviors through medical record review or procedural code provides critical information about effectiveness of the practice change.

A 2014 Institute of Medicine (IOM) report noted that nearly two decades may pass before psychological health research findings become part of routine clinical practice in the Departments of Defense (DoD) and Veterans Affairs (VA).

In 2012 DoD started working with the VA to study research translation structures in both departments. The PBI Network is the collaborative organizational infrastructure that promotes and supports the rapid translation of psychological health (PH) research findings into clinical practice. This poster focuses primarily on DoD efforts.

The PBI Network was based on Stetler’s 2011 framework for Promoting Action on Research Implementation in Health Services (PARiHS) to implement psychological health evidence-based practices (EBPs), and the VA Quality Enhancement Research Initiative (QUERI) model.

The PBI Network training and facilitation process helps the larger system identify barriers and solutions for selected practice changes. This informs feasibility and capacity-building decisions prior to widespread enterprise dissemination.

A PBI Network information technology platform and website enhances communication and knowledge exchange between implementation-trained providers at PBI Network sites and across departments.

THE PBI NETWORK

1. Department of Veterans Affairs and Department of Defense Joint Executive Council. Joint strategic plan fiscal years 2011-2013. Department of Defense and Department of Veterans Affairs. 2011. https://www.va.gov/op3/docs/StrategicPlanning/VA_DoD_JEC_Joint_Strategic_Plan_FY_2011_2013_final_with_Addendum.pdf. Accessed 9 Aug 2017.2. Department of Defense and Department of Veterans Affairs. (2011). DoD/VA integrated mental health strategy (IMHS): Strategic action summaries. Department of Defense and Department of Veterans Affairs. Washington, DC. https://www.mentalhealth.va.gov/docs/VA-DoD_IMHS_Action_Summaries_040814.pdf. Accessed 09 Aug 2017.3. Department of Defense. Practice-based implementation network outcome monitoring project: Internal Implementation Plan for the DoD PBI Network Management. Silver Spring, Maryland; Unpublished Report, Deployment Health Clinical Center, Defense Centers of Excellence for Psychological Health and TBI: 2014.4. Stetler CB, Damschroder LJ, Helfrich CD, Hagedorn HJ. A guide for applying a revised version of the PARIHS framework for implementation. Implementation Science. 2011 Aug 30;6(1):99.5. Department of Veterans Health Administration, Health Services Research & Development. Quality enhancement research initiative: Implementation guide. Washington, DC; Health Services Research & Development Service. 2013. http://www.queri.research.va.gov/implementation/ImplementationGuide.pdf.

Accessed 09 Aug 2017.6. Institute of Medicine. Treatment for posttraumatic stress disorder in military and veteran populations: Final assessment. Washington, DC: The National Academies Press; 2014.7. Woodson J. Military treatment facility mental Health Clinical Outcomes Guidance. Washington, DC: Assistant Secretary of Defense, Health Affairs, Department of Defense; 2013. 8. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.9. Department of Defense. Final report: DoD and VA establishment of a practice-based implementation network in mental health. Unpublished Report, Silver Spring, MD. Deployment Health Clinical Center, Defense Centers of Excellence for Psychological Health and TBI. 2016.

• IMPLEMENTATION SCIENCE WEBSITE• IMPLEMENTATION SCIENCE NEWSLETTER• IMPLEMENTATION SCIENCE PRESENTATION SERIES

HTTP://WWW.PDHEALTH.MIL/NODE/2964

CONNECT WITH THE PBI NETWORK AT:http://pdhealth.mil/research-analytics/dodva-pbi-networkusarmy.ncr.medcom-usamrmc-dcoe.mbx.dhcc-pbi-network@mail.milusarmy.ncr.medcom-usamrmc-dcoe.mbx.dhcc-pbin-tech-into-care@mail.mil

RESOURCES

POINT OF CONTACT: Jorielle B. Houston Ph.D., Section Chief, Practice-Based Implementation Network, Psychological Health Center of Excellence (PHCoE), jorielle.b.houston.mil@mail.mil

REFERENCES