Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS) to increase evidence based psychotherapy in military behavioral health clinics: Design of a cluster-randomized stepped-wedge implementation study

• Published in: Contemporary clinical trials Vol. 93; p. 106008
• Main Authors: Rosen, Craig S., Davis, C. Adrian, Riggs, David, Cook, Jeffery, Peterson, Alan L., Young-McCaughan, Stacey, Comtois, Katherine Anne, Haddock, Christopher K., Borah, Elisa V., Dondanville, Katherine A., Finley, Erin P., Jahnke, Sara A., Poston, Walker S.C., Wiltsey-Stirman, Shannon, Neitzer, Andrea, Broussard, Capt Rachel, Brzuchalski, MAJ Amy, Clayton, Maj Spencer P., Conforte, LT Allison M., Flores, Araceli, Hein, Jessica, Keith, Capt Felicia, Jinkerson, Capt Jeremy, Letendre, Margaret, Nofziger, Debra, Pollick, Kirsten, Santiago, Capt Kyra, Waggoner, Lt Col John, Woodworth, Craig, McLean, Carmen P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2020
• Subjects: External facilitation; Female; Health Knowledge, Attitudes, Practice; Health Personnel - education; Humans; Implosive Therapy - methods; Inservice Training; Male; Mental Health; Mental Health Services - organization & administration; Military; Military Personnel; Multicenter Studies as Topic; Patient Satisfaction; Prolonged exposure therapy; Psychotherapy - methods; PTSD; Randomized Controlled Trials as Topic; Research Design; Rubric; Stress Disorders, Post-Traumatic - therapy; Tailored implementation; Toolkit-guided facilitation; Rubric; ProQOL-5; FTP; BH; Prolonged exposure therapy; PHQ-9; BHDP; EHR; ILS; SDD; CFIR; GAD-7; NLP; TACTICS; HIPAA; MHS; Military; EBPs; External facilitation; DSM-5; GLMM; Toolkit-guided facilitation; ERIC; PCL-5; VA; Tailored implementation; PTSD; MTFs; Site PI; ICD-9; PE; DoD; ICS; IRB; U.S; DHA
• ISSN: 1551-7144; 1559-2030
• DOI: 10.1016/j.cct.2020.106008

Despite efforts by the U.S. Department of Defense to train behavioral health (BH) providers in evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), numerous barriers limit EBP implementation. A context-tailored implementation approach called TACTICS (Targeted Assessment and Context-Tailored Implementation of Change Strategies) holds promise for increasing the use of EBPs such as prolonged exposure therapy (PE) in military treatment facilities. TACTICS combines a needs assessment, a rubric for selecting implementation strategies based on local barriers, an implementation toolkit, and external facilitation to support local champions and their implementation teams in enacting changes. This paper describes the rationale for and design of a study that will evaluate whether TACTICS can increase implementation of PE for PTSD and improve patient outcomes in military BH clinics relative to provider training in PE alone. The study is a multi-site, cluster randomized, stepped-wedge trial, with the military treatment facility as the unit of analysis. Eight facilities undergo a provider-training phase, followed by 5 months of TACTICS implementation. The timing of TACTICS at each facility is randomly assigned to begin 9, 14, or 19 months after beginning the provider-training phase. Primary analyses will compare the proportion of PTSD patients receiving PE and patients' mean improvement in PTSD symptoms before and after the onset of TACTICS. TACTICS endeavors to balance standardization of empirically-supported implementation strategies with the flexibility of application necessary for success across varied clinical settings. If successful, TACTICS may represent a systematic and scalable method of promoting and supporting EBP implementation. Clinicaltrials.gov Identifier: NCT03663452