Developing alternative training delivery methods to improve Psychotherapy implementation in the U.S. department of Veterans affairs

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 skills. VA has a broad impact on the training of mental health professionals in the United States, training over 11,600 unique mental health staff in 1 or more of these EBPs since 2007. Original EBP training delivery methods relied on in-person workshops, followed by consultation with an EBP expert who provided feedback and ratings of audio-recorded sessions. Restrictions on federal government employee travel, in-person conferences, and budgets led to reductions in the number of mental health providers trained in EBPs during recent fiscal years. As a result, alternative training delivery methods were needed for training VA staff. This article describes the process used to select, develop, and pilot test alternative training delivery methods for EBPs. Surveys of key stakeholders and a literature review led us to retain consultation with review of audio-recorded sessions since evidence suggests this is critical to changing clinician behavior. All VA EBP training programs have begun pilot testing blended learning, regional training, or both, depending on local needs. Early results suggest that regional training (train the trainer method) was equivalent to, while blended learning methods showed mixed results relative to, the traditional training method. These alternative training methods may be more sustainable for training psychotherapists in large health care systems or across distances.