# Reaping the Wisdom of Positive Deviants to Increase the Reach of Family Involvement in PTSD Treatment

> **NIH VA I21** · VA BOSTON HEALTH CARE SYSTEM · 2020 · —

## Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) is a devastating illness that has substantial costs to
Veterans, their families, and the Veterans Health Administration (VA). Although effective treatments for PTSD
exist, high rates of treatment dropout and generally sub-optimal response rates remain common. Incorporating
family members in treatment represents one avenue for improving outcomes and providing Veteran-centered
care, and surveys of Veterans in outpatient VA PTSD care indicate that 80% are interested in family
involvement. However, despite this strong interest and potential for benefit, national administrative data show
that <1% of Veterans in VA PTSD treatment have even a single family-involved session. To understand the
factors contributing to the use of family involvement in PTSD treatment, the project team proposes a study
using qualitative methods to assess relevant contextual factors.
SIGNIFICANCE/IMPACT: The project is highly responsive to HSR&D’s Research Priorities, particularly the
Whole Health approach to care which emphasizes the salience of Veterans’ broader context as a cornerstone
of health and wellness. The project also has the potential to advance PTSD treatment for Veterans by distilling
wisdom from facilities that have had relatively greater success in implementing family-inclusive care. Given the
substantial disease burden of PTSD among VA patients, enhancing our treatment of this disorder would
meaningfully improve the lives of millions of Veterans.
INNOVATION: Despite research documenting the important bidirectional impacts between PTSD symptoms
and social support, and the ways that family functioning and behaviors can impact PTSD treatment (in both
positive and negative directions), to our knowledge there has been no systematic research to understand how
family involvement is implemented in practice in VA.
SPECIFIC AIMS: (1) To identify current practices, attitudes, and facilitators and barriers to family involvement
through key stakeholder interviews (total n ≥ 30) at 5 “positive deviant” and 5 “lower-involvement” VA facilities.
(2) To identify best clinical practices and recommendations for enhancing the implementation of family
involvement through input from a Stakeholder Advisory Board.
METHODOLOGY: The project is guided by the i-PARIHS framework. A Stakeholder Advisory Board (SAB)
composed of operational partners, Veterans and family members, and other individuals with key knowledge will
provide guidance and feedback throughout all phases of the project. Regarding methods, interviews will be
conducted with clinicians and administrators at “positive deviant” VA facilities (those in the 90th percentile
nationally with respect to incorporating family members into Veterans’ PTSD treatment), as well as at “lower-
involvement” facilities (those in the 10th percentile). The premise of the positive deviant approach is that some
members of a community have already discovered innovative solutions to problems which fa...

## Key facts

- **NIH application ID:** 10066134
- **Project number:** 1I21HX003237-01
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Johanna Thompson-Hollands
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-09-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10066134

## Citation

> US National Institutes of Health, RePORTER application 10066134, Reaping the Wisdom of Positive Deviants to Increase the Reach of Family Involvement in PTSD Treatment (1I21HX003237-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10066134. Licensed CC0.

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