Evaluating a Community-Based Training Program for Evidence-Based Treatments for PTSD Using the RE-AIM Framework

Community mental health providers increasingly serve veterans with posttraumatic stress disorder (PTSD). However, recent surveys find that less than 20% of community providers are adequately trained to implement evidence-based treatments (EBTs) for PTSD. Since 2017, the STRONG STAR Training Initiative (SSTI) model has adapted traditional learning collaboratives aimed at increasing availability of EBTs for PTSD in community settings. This study reports on STRONG STAR program evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess dissemination and implementation outcomes. Between January 2018 and January 2020, 280 mental health providers from 25 states participated. Providers initiating EBTs for PTSD with 930 patients, reaching 29% who had PTSD among their caseload. Overall, 238 of patients who initiated EBT completed treatment. Patients who completed treatment demonstrated a 32.51-point decrease, t(237) = 25.27, p < .001, in PTSD symptom severity and an 8.73-point decrease, t(231) = 19.95, p < .001, in depression symptom severity following treatment. High rates of SSTI providers continued implementing EBT for PTSD at 6 months (cognitive processing therapy [CPT]: 95%; prolonged exposure [PE]: 72%) and 1-year (CPT: 87%; PE: 77%) posttraining, similar to outcomes reported by community and Department of Veterans Affairs providers. In reporting on the first evaluation of a National Training Program for community-based mental health providers, we look ahead to continued work in refining scalable models for building provider competence in delivery of EBTs. Impact Statement There is need for scalable, resource efficient training models for mental health providers in community settings. Findings presented indicate that not only was STRONG STAR able to reach community providers, but they actively engaged in the training program, gained skills for delivery of evidence-based treatments in their unique settings-demonstrated by substantial symptom improvement among enrolled patients-and were able to sustain use of the therapies over time.