# Increasing Reach of Evidence-Based Psychotherapies in CBOCs: Identifying Needs and Strategies for Scale Out

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

## Abstract

Evidence-based psychotherapies (EBPs) have demonstrated effectiveness for numerous presenting problems
including posttraumatic stress disorder, depression, and anxiety. Rates of these disorders are elevated in
Veterans, creating a significant public health impact. Untreated mental health diagnoses increase risk of
suicide, further elevating the need for effective treatments. Efforts to treat these mental health problems within
the Department of Veterans Affairs (VA) have largely been addressed through national EBP rollouts. These
EBP rollouts have been disseminated broadly, yet limited uptake has been demonstrated across VA settings,
especially in Community Based Outpatient Clinics (CBOCs). Access to EBPs through CBOCs is crucial to
increase timeliness and efficiency in mental healthcare as more than half of Veterans utilizing the VA system
go to CBOCs for care. Moreover, Veterans presenting to rural CBOCs are receiving significantly less mental
health appointments compared to urban CBOCs, highlighting a discrepancy in access to care by location.
Although we know that rural Veterans are receiving less care, most of the research on EBP implementation
has been done outside of the CBOC setting. Identifying what care Veterans in CBOCs are getting, why they
may not be getting EBPs, and how to meet the needs of CBOC providers is vital to enhancing access to EBPs
through tailored implementation strategies. Without this information, enhanced implementation of EBPs in
CBOCs is unlikely and the access to mental health care problem will be perpetuated. To maximize the
likelihood of broad EBP implementation in CBOCs, it is essential that implementation strategies are feasible
and acceptable in CBOC contexts, which includes consideration for both rural and urban settings. EBP
implementation in the VA system has traditionally been a top-down approach, which may ignore important
contextual factors that impact successful implementation. Important factors that are often overlooked include,
the potential need for adaptations to interventions and delivery to best fit context of care. Given that CBOCs
differ significantly from main VA hospitals, understanding the impact of these factors is important. Important
information about these contextual factors can be obtained through qualitative interview with CBOC providers
in rural and urban settings. This project will maximize a unique opportunity to understand the potential fit of
alternative approaches for EBP delivery in CBOCs to enhance reach and sustainment of EBPs. Research will
be guided by evidence-based conceptual frameworks and will utilize a stakeholder advisory board to produce
expert recommendations to enhance implementation strategies in rural and urban CBOCs. The research study
will be conducted by a team of investigators with expertise in implementation science, qualitative analyses and
EBPs within the VA systems. With input from operational partners, the resulting products have the potential to
significa...

## Key facts

- **NIH application ID:** 9717703
- **Project number:** 1I21HX002802-01
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Katherine M Iverson
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2019-10-01 → 2020-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9717703

## Citation

> US National Institutes of Health, RePORTER application 9717703, Increasing Reach of Evidence-Based Psychotherapies in CBOCs: Identifying Needs and Strategies for Scale Out (1I21HX002802-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9717703. Licensed CC0.

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