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104
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3,182
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Introduction
Current institution
Additional affiliations
January 2016 - present
October 2015 - present
August 2010 - November 2015
Education
August 2003 - May 2008
August 2001 - May 2003
August 1997 - May 2001
Publications
Publications (104)
Context:
Dialectical Behavior Therapy (DBT) is an evidence-based therapy developed for the treatment of suicidal behaviors and disorders characterized by emotional and behavioral dyscontrol that is effective in veteran populations. The impact of DBT on veterans' Veterans Affairs (VA) service utilization and cost is unknown.
Evidence acquisition:...
Background:
With the current funding climate and need for advancements in implementation science, there is a growing demand for grantsmanship workshops to increase the quality and rigor of proposals. A group-based implementation science-focused grantsmanship workshop, the Implementation Development Workshop (IDW), is one methodology to address thi...
National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administration (VHA) provides important lessons on the barriers and facilitators to implementation in a large healthcare system. Little is known about barriers and facilitators to the implementation of a complex EBP for emotional and behavioral dysregulation—dia...
Objective:
Suicide is a leading cause of death in the United States. This has prompted the U.S. surgeon general to issue a report describing actionable items to reduce suicide rates, including a recommendation to increase the use of the caring letters intervention. This intervention involves mailing brief, nondemanding messages of care. As part of...
This article provides new reflections and recommendations from authors of the initial effectiveness-implementation hybrid study manuscript and additional experts in their conceptualization and application. Given the widespread and continued use of hybrid studies, critical appraisals are necessary. The article offers reflections across five conceptu...
Reducing veteran suicide is a high priority for the Veterans Health Administration (VHA). While dialectical behavior therapy skills groups (DBT-SG) may be as effective as comprehensive DBT in reducing suicide attempt, barriers and facilitators to this innovation in VHA are not well known. In preparation for a hybrid Type 1 effectiveness-implementat...
Veteran suicide is a public health crisis. Suicide rates for U.S. veterans have remained disproportionately higher than their nonveteran counterparts during the last 2 decades (White House, 2023; U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Community-Based Interventions for Suicide Prevention, 2022). Addition...
Background
Preventing veteran suicide requires addressing mechanisms driving suicidal behavior, such as emotion dysregulation. Dialectical Behavior Therapy Skills Groups (DBT-SG) are well established for reducing emotion dysregulation, improving coping skills, and in some studies, reducing suicide attempt, but will require implementation support to...
Introduction
Veterans are at greater risk for suicide than non-veterans; veterans who call the Veterans Crisis Line are at even higher risk. Firearms and poisoning are among the most common methods by which people die by suicide in the United States and access to those lethal means are risk factors for suicide. The United States Department of Veter...
Background
The period after psychiatric hospital discharge is one of elevated risk for suicide‐related behaviors (SRBs). Post‐discharge clinical outreach, although potentially effective in preventing SRBs, would be more cost‐effective if targeted at high‐risk patients. To this end, a machine learning model was developed to predict post‐discharge su...
OBJECTIVE
Iatrogenic blood losses from repetitive laboratory testing are a leading cause of anemia of prematurity and blood transfusions. We used an implementation science approach to decrease iatrogenic blood losses during the first 3 postnatal weeks among very low birth weight infants.
METHODS
We performed qualitative interviews of key stakehold...
Transferring successful implementation strategies from research to practice requires approaches for assessing fidelity to the strategy’s core components. Implementation facilitation (IF) is a strategy involving an interactive process of problem-solving, enabling, and supporting individuals in efforts to implement clinical innovations that occurs in...
Importance
Caring letters is an evidence-based suicide prevention intervention in acute care settings, but its outcomes among individuals who contact a national crisis line have not previously been evaluated.
Objective
To examine the outcomes of the Veterans Crisis Line (VCL) caring letters intervention and determine whether there are differences...
Objective:
In 2017, the Veterans Health Administration (VHA) implemented a national suicide prevention program, called Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), that uses a predictive algorithm to identify, attempt to reach, assess, and care for patients at the highest risk for suicide. The authors ai...
Transgender and gender diverse (TGD) veterans in the Veterans Health Administration experience health and health care disparities, and research with this population is needed to improve gender-affirming care in Veterans Health Administration. However, TGD veterans may experience hesitancy to participate in research. We must address barriers to part...
Background
In the United States Department of Veterans Affairs (VA), veterans who are lesbian, gay, bisexual, transgender, queer, and similar gender and sexual minoritized people (LGBTQ+) experience health disparities compared to cisgender, heterosexual veterans. VA’s LGBTQ+ Health Program created two healthcare policies on providing LGBTQ+ affirmi...
Suicide prevention is a clinical priority for the US Veterans Health Administration. Evidence-based interventions, including developing a suicide safety plan, are recommended practices and are becoming more widespread. Adaptations to further augment safety planning include a manualized group intervention (Project Life Force, PLF) that combines safe...
Background:
Evidence-Based Quality Improvement (EBQI) involves researchers and local partners working collaboratively to support the uptake of an evidence-based intervention (EBI). To date, EBQI has not been consistently included in community-engaged dissemination and implementation literature. The purpose of this paper is to illustrate the steps,...
Objective:
The authors sought to determine the effectiveness of a self-administered computerized mental health screening tool in a general acute care emergency department (ED).
Methods:
Changes in patient care (diagnosis of a past-year psychiatric disorder, request for psychiatric consultation, psychiatric referral at discharge, or transfer to p...
Introduction:
Dialectical behavior therapy (DBT) is a multimodal evidence-based suicide prevention psychotherapy with barriers to full implementation. This study qualitatively examined barriers and facilitators to the DBT skills group treatment mode, which can be implemented as a stand-alone intervention. Using data from a national mixed-methods p...
Introduction:
Effective, brief, low-cost interventions for suicide attempt survivors are essential to saving lives and achieving the goals of the National Strategy for Suicide Prevention and Zero Suicide. This study aims to examine the effectiveness of the Attempted Suicide Short Intervention Program (ASSIP) in averting suicide reattempts in the U...
Importance
The months after psychiatric hospital discharge are a time of high risk for suicide. Intensive postdischarge case management, although potentially effective in suicide prevention, is likely to be cost-effective only if targeted at high-risk patients. A previously developed machine learning (ML) model showed that postdischarge suicides ca...
Mental illness and suicide are significant public health problems. Limited resources put individuals at greater risk, particularly in rural areas with fewer health providers. Community pharmacists are the most accessible health professionals in rural communities and are interested in addressing mental health concerns. Research is limited on how to...
Introduction
Lethal means safety counseling (LMSC) is an evidence-based suicide prevention intervention during which providers encourage patients to limit their access to lethal means (e.g., firearms, medications). Despite agreement about the importance of LMSC, it is underutilized in clinical practice.
Methods
To better understand the individual...
Background
The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and its predecessor, PARIHS, have been widely utilized in implementation studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and res...
The U.S. Veterans Health Administration developed a suicide prediction statistical model and implemented a novel clinical program, Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET). This high-value suicide prevention program aims to efficiently identify patients at risk and connect them with care. Starting in A...
Background: The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, and its predecessor PARIHS, have been widely utilized in implementations studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and r...
Measurement-Based Care (MBC) is the use of patient-reported outcome measures repeatedly over the course of treatment to track progress and empower both providers and patients to collaboratively set goals and plan treatment. The Measurement-Based Care in Mental Health Initiative within the Department of Veterans Affairs' Office of Mental Health and...
Background: To ensure appropriate transfer of successful implementation strategies from research to policy and practice, it is important to use tools to measure and support fidelity to an implementation strategy’s core components. Unfortunately, this aspect of implementation science is underdeveloped and infrequently applied. Implementation facilit...
Objective:
To describe the design, implementation, and plans to evaluate the Veterans Crisis Line (VCL) Caring Letters intervention.
Data sources:
Veterans with VCL contact and VHA service utilization.
Study design:
Caring Letters is an evidence-based post-acute care suicide prevention intervention in which brief messages are mailed to individ...
Caring Letters is recommended in multiple best practice guidelines; however, the Caring Letters intervention has not been widely implemented. The process of tracking, scheduling, and mailing letters for multiple patients over many months may represent a significant barrier for busy clinicians. This evaluation examined whether the use of centralized...
Background: The terminology and constructs of theories, models, and frameworks (TMFs) can provide a common language that enhances our ability to talk about implementation processes and fosters our ability to synthesize research findings across studies. Use of a deductive codebook based on a TMF can help investigators focus analysis of qualitative d...
Background: The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, and its predecessor PARIHS, have been widely utilized in implementations studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and r...
Introduction
Implementation researchers could draw from participatory research to engage patients (consumers of healthcare) in implementation processes and possibly reduce healthcare disparities. There is a little consumer involvement in healthcare implementation, partially because no formal guidance exists. We will create and pilot a toolkit of me...
Desde los primeros años de su desarrollo, la psicoterapia analítico-funcional (PAF) ha sido apreciada por su innovación clínica y su poder de transformación con clientes con todo tipo de problemáticas. Basándose en los fundamentos de sus anteriores volúmenes sobre esta versátil terapia, los editores de La práctica de la psicoterapia analítico-funci...
The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the United States Department of Veterans Affairs (VA), Veterans Health Administration (VHA), or the United States Government. Some of the content in this paper was derived from presentations given by the first and last authors at the...
Transitions in care, such as discharge from an emergency department (ED), are periods of increased risk for suicide and effective interventions that target these periods are needed. Caring Contacts is an evidence-based suicide prevention intervention that targets transitions, yet it has not been widely implemented. This pilot study adapted Caring C...
Importance:
The Veterans Health Administration (VHA) implemented a national clinical program using a suicide risk prediction algorithm, Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), in which clinicians facilitate care enhancements for individuals identified in local top 0.1% suicide risk tiers. Evaluation...
Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy (EBP) for repeated suicidal and nonsuicidal self-injury and Borderline Personality Disorder. There has been little research on the effectiveness or implementation of DBT via telehealth. However, literature has demonstrated that other EBPs delivered via telehealth are just as effe...
Neurological disorders are the leading cause of disability and the second leading cause of death globally. To challenge this enormous disease burden, scientists are pursuing innovative solutions to maintain and improve the quality of neurologic care. Despite the availability of many effective evidence-based practices, many patients with neurologica...
Mental health clinicians and administrators are increasingly asked to collect and report treatment outcome data despite numerous challenges to select and use instruments in routine practice. Measurement-based care (MBC) is an evidence-based practice for improving patient care. We propose that data collected from MBC processes with patients can be s...
Trauma exposure and mental health problems adversely affect work functioning. Sexual minority women are at increased risk for trauma exposure, depression, and PTSD. Sexual minority women also experience unique stressors related to their sexual orientation, which can directly impact work functioning. However, little research to date has examined the...
Objective
To describe the development and approach of a Dissemination and Implementation (D&I) core created within the Military Suicide Research Consortium, a funding consortium of the Department of Defense, to promote the D&I of findings from funded research.
Approach
The approach of the D&I Core is described as it developed over the past four ye...
There is a very high suicide rate in the year after psychiatric hospital discharge. Intensive postdischarge case management programs can address this problem but are not cost-effective for all patients. This issue can be addressed by developing a risk model to predict which inpatients might need such a program. We developed such a model for the 391...
A proof-of-concept practice-based implementation network was developed in the US Departments of Veteran Affairs (VA) and Defense to increase the speed of implementation of mental health practices, derive lessons learned prior to larger-scale implementation, and facilitate organizational learning. One hundred thirty-four clinicians in 18 VA clinics...
As the field of implementation has rapidly evolved, distinct implementation science and practice components have emerged. Siloing based on professional identities is beginning to occur, with a lack of adequate opportunities for implementation intermediaries, practice leaders, policy leaders, and researchers to interact and collaborate. This chapter...
Dialectical behavioral therapy (DBT) is a useful evidence-based psychotherapy for treatment of veterans with suicidality and emotion dysregulation. While DBT has not been systematically implemented across the Department of Veterans Affairs (VA), it has spread throughout the system by clinicians interested in treating suicidality and emotion dysregu...
Dialectical Behavioral Therapy (DBT) is an effective treatment for borderline personality disorder (BPD), yet many health care facilities struggle to implement one of the modes of DBT, phone coaching. The aims of this study were to present barriers and reported solutions regarding the implementation of DBT phone coaching. We conducted a sequential...
The traditional research pipeline that encourages a staged approach to moving an intervention from efficacy trials to the real world can take a long time. To address this issue, hybrid effectiveness-implementation designs were codified to promote examination of both effectiveness and implementation outcomes within a study. There are three types of...
Background:
Suicide among veterans is a problem nationally, and suicide prevention remains a high priority for the Department of Veterans Affairs (VA). Focusing suicide prevention initiatives in the emergency department setting provides reach to veterans who may not be seen in mental health and targets a critical risk period, transitions in care f...
HIV is a health problem for sexual minority men in the United States. One factor among many that contributes to this HIV disparity is poor patient-provider interactions. We focused on specific provider behavior preferred by sexual minority men during patient-provider interactions about HIV prevention. We interviewed 20 HIV-negative sexual minority...
The traditional research pipeline that encourages a staged approach to moving an intervention from efficacy trials to the real world can take a long time. To address this issue, hybrid effectiveness-implementation designs were codified to promote examination of both effectiveness and implementation outcomes within a study. There are three types of...
Background
Patients admitted to the hospital after an injury are at a greater risk for developing post-traumatic stress disorder (PTSD) due to the nature of the injury and the traumatic nature of necessary medical interventions. Many level I trauma centers have yet to implement screening protocols for PTSD risk. The goal of the study was to charact...
In contrast to a top-down dissemination approach, the present approach identified existing clinicians using an evidence-based psychotherapy (EBP), dialectical behavior therapy, throughout the Department of Veterans Affairs (VA) system, and created a virtual community of practice (VCoP) to facilitate sharing of materials, resources, information, and...
This commentary reflects on key challenges raised across the articles of this special issue, notably the tension between fidelity and adaptation, the importance of articulating core components and principles of evidence-based programs, the need for pragmatic measures, and the challenges associated with articulating and testing mechanisms of impleme...
Dialectical Behavior Therapy (DBT) prioritizes suicidal behavior and other self-directed violence as the primary treatment targets, and has been demonstrated to reduce self-directed violence in clinical trials. This paper synthesizes findings from controlled trials that assessed self-directed violence and suicidality, including suicide attempts, no...
The re-conceptualization of knowledge translation (KT) in Kitson and colleagues' manuscript "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation" is an advancement in how one can incorporate implementation into the KT process. Kitson notes that "the challenge is to explain how it might help in the healthcare policy, pra...
Four decades of research has indicated that the Caring Contacts intervention may be an efficacious, scalable, and low-cost intervention for reducing suicide behaviors. The implementation of the intervention requires careful consideration of the target population, message content, delivery options, and modalities of the contacts (e.g., postal mail,...
The Department of Veteran Affairs (VA) has been a recognized leader in evidence-based psychotherapy (EBP) training, with 15 different EBP training programs that address posttraumatic stress disorder (PTSD), depression, chronic pain, insomnia, substance use, motivation for treatment, relationship distress, serious mental illness, and problem-solving...
Because suicide risk appears to be heightened with individuals who have posttraumatic stress disorder (PTSD), it is crucial that PTSD treatment providers assess for suicidal ideation and that, when mental health clinicians are working with a suicidal patient, they assess for PTSD. Evidence-based treatments for PTSD can significantly help those expe...
The advancement of implementation science is dependent on identifying assessment strategies that can address implementation and clinical outcome variables in ways that are valid, relevant to stakeholders, and scalable. This paper presents a measurement agenda for implementation science that integrates the previously disparate assessment traditions...
Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with re...
Background
Rates of treatment dropout in outpatient Dialectical Behavior Therapy (DBT) in the community can be as high as 24 % to 58 %, making dropout a great concern. The primary purpose of this article was to examine predictors of dropout from DBT in a community mental health setting.
Methods
Participants were 56 consumers with borderline person...
Context:
Little is known about nonresearch training experiences of providers who implement evidence-based psychotherapies for suicidal behaviors among veterans.
Evidence acquisition:
This national program evaluation identified the history of training, training needs, and desired resources of clinicians who work with at-risk veterans in a nationa...
The purpose of this study was to examine trends and barriers in implementation of dialectical behavior therapy (DBT) programs in college counseling centers (CCCs). Participants were 107 CCC employees who participated in an electronic survey. One third of respondents endorsed use or planned use of DBT at their centers. The most prevalent primary mod...
Table of contents
Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships
Cara Lewis, Doyanne Darnell, Suzanne Kerns, Maria Monroe-DeVita, Sara J. Landes, Aaron R. Lyon, Cameo Stanick, Shannon Dorsey, Jill Locke, Brigid Ma...
Background
Broadly disseminating and implementing evidence-based psychotherapies with high fidelity, particularly cognitive behavioral therapy (CBT), has proved challenging for many health-care systems, including the Department of Veterans Affairs, especially in primary care settings such as small or remote clinics. A computer-based tool (based on...
Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based
treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation,
while targeting challenging behaviors. DBT has b...
Given the importance of implementing measurement-based care (MBC) to enhance the quality of care provided to veterans with mental health disorders, the Department of Veterans Affairs (VA) has developed guidelines and a mandate for MBC and use of specific measures. Nonetheless, current use of MBC for mental health in VA is low and easily extractable...
Guided by the Consolidated Framework for Implementation Research, this mixed method study explored the relationship between inner setting variables and dialectical behavior therapy (DBT) implementation. Intensively trained DBT clinicians completed an online quantitative survey (n = 79) and a subset were sequentially interviewed using qualitative me...
An analogue study was conducted to examine differences in women's preference for and anticipated comfort self-disclosing to hypothetical therapists of different sexes based on the type of hypothetical presenting problem. The impact of general level of self-disclosure was also examined. Participants included female college students (n=187). Anticipa...
This article addresses the issue of complex trauma in veterans and treatments for symptom presentations resulting from complex trauma exposure. While various definitions have been proposed for complex trauma, the clinical issues related to it are relevant for veterans as they are at risk for cumulative trauma exposures such as multiple combat deplo...
Basic behavioral principles (e.g., reinforcement) are compelling candidates for research isolating and evaluating psychotherapy mechanisms of change in contextual behavioral science. Functional Analytic Psychotherapy (FAP) is a contextual behavioral treatment approach that teaches therapists to employ behavioral principles, including the evocation...
The purpose of this study was to identify outpatients who experience entrenched suicidal ideation following inpatient psychiatric hospitalization. Our findings suggest that the use of a suicidal ambivalence index score was helpful at discriminating those who reported significantly greater ratings of suicidal ideation across a 1-year period of time,...
Building upon the multidisciplinary literature on the science of dissemination and implementation, this title examines state-of-the-art programs to improve access to psychological interventions. Renowned experts describe leading efforts to facilitate the transport of evidence-based treatments, alongside innovative strategies for achieving the goals...
Functional analytic psychotherapy (FAP) provides a behavioral analysis of the psychotherapy relationship that directly applies basic research findings to outpatient psychotherapy settings. Specifically, FAP suggests that a therapist's in vivo (i.e., in-session) contingent responding to targeted client behaviors, particularly positive reinforcement...
Despite the ubiquity of suicidality in behavioral health settings, empirically supported interventions for suicidality are surprisingly rare. Given the importance of resolving suicidality and therapists' anxieties about treating suicidal patients, there is a clear need for innovative services and clinical approaches. The purpose of the current stud...
The study examined the degree to which trauma was addressed among clients being treated for a severe mental illness and a substance use disorder at a community mental health center.
Participants (N=74) were a randomly selected sample of clients who were enrolled for at least two years in an outpatient clinic and who had at least one clinic visit in...
Empirical evidence supports cognitive -behavioral interventions for the treatment Posttraumatic Stress Disorder (PTSD), with exposure therapy typically being the most frequently utilized. While the success of exposure treatments is well established there are factors which may hinder their use in “real-world” settings (e.g., poor treatment complianc...
This chapter explores the intersections of Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009
) and Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b
) with a focus on how training and experience with each model can enhance work with the other.
Depressive disorders constitute a serious problem in the United States and around the world. The appearance of practice guidelines and lists of evidenced-based therapies suggests that adequate treatments for depression exist. However, a careful consideration of what is known and not known about the treatment of depression leaves plenty of room for...
To improve cognitive and behavioral therapies (CBT) for depression, several approaches recommend an increased focus on the occurrence of problems as they occur in the therapeutic relationship or in relation to the live therapy process, referred to as present-focused. A lingering question has been the degree to which CBT therapists already engage in...
In this article we discuss the traditional behavioral models of depression and some of the challenges analyzing a phenomenon with such complex and varied features. We present the traditional model and suggest that it does not capture the complexity of the phenomenon, nor do syndromal models of depression that dominate the mainstream conceptualizati...
Individual Beck Depression Inventory (BDI) time courses of 38 clients receiving cognitive therapy (CT) and a modified form of CT were studied in order to investigate temporal changes during CT for depression. The primary aim was to determine if alternative methods of defining and computing gains occurring early in CT would alter the conclusions dra...
