The influence of team functioning and workload on sustainability of trauma-Focused evidence-Based psychotherapies

David C. Mohr, Craig S. Rosen, Paula P. Schnurr, Robert J. Orazem, Siamak Noorbaloochi, Barbara A. Clothier, Afsoon Eftekhari, Nancy C. Bernardy, Kathleen M. Chard, Jill J. Crowley, Joan M. Cook, Shannon M. Kehle-Forbes, Josef I. Ruzek, Nina A. Sayer

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7 Scopus citations


Objective: It has been over a decade since the U.S. Department of Veterans Affairs (VA) began formal dissemination and implementation of two trauma-focused evidence-based psychotherapies (TF-EBPs). The objective of this study was to examine the sustainability of the TF-EBPs and determine whether team functioning and workload were associated with TF-EBP sustainability. Methods: This observational study used VA administrative data for 6,251 patients with posttraumatic stress disorder (PTSD) and surveys from 78 providers from 10 purposefully selected PTSD clinical teams located in nine VA medical centers. The outcome was sustainability of TF-EBPs, which was based on British National Health System Sustainability Index scores (possible scores range from 0 to 100.90). Primary predictors included team functioning, workload, and TB-EBP reach to patients with PTSD. Multiple linear regression models were used to examine the influence of team functioning and workload on TF-EBP sustainability after adjustment for covariates that were significantly associated with sustainability. Results: Sustainability Index scores ranged from 53.15 to 100.90 across the 10 teams. Regression models showed that after adjustment for patient and facility characteristics, team functioning was positively associated (B=9.16, p,.001) and workload was negatively associated (B=–.28, p,.05) with TF-EBP sustainability. Conclusions: There was considerable variation across teams in TF-EBP sustainability. The contribution of team functioning and workload to the sustainability of evidence-based mental health care warrants further study.

Original languageEnglish (US)
Pages (from-to)879-886
Number of pages8
JournalPsychiatric Services
Issue number8
StatePublished - Aug 2018

Bibliographical note

Funding Information:
Dr. Mohr is with the Center for Healthcare Organization and Implementation Research and Dr. Kehle-Forbes is with the National Center for PTSD Women’s Health Sciences Division, U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston. Dr. Mohr is also with the School of Public Health, Boston University, Boston. Dr. Kehle-Forbes is also with the Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, where Mr. Orazem, Dr. Noorbaloochi, Ms. Clothier, and Dr. Sayer are affiliated. Dr. Noorbaloochi and Dr. Sayer are also with the Department of Medicine, University of Minnesota, Minneapolis. Dr. Rosen, Dr. Eftekhari, Dr. Crowley, and Dr. Ruzek are with the Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California. Dr. Rosen and Dr. Ruzek are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California. Dr. Schnurr and Dr. Bernardy are with the Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and also with the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Chard is with the PTSD Division, Cincinnati VA Medical Center, Cincinnati. Dr. Cook is with the Evaluation Division, National Center for PTSD, and with the Yale University School of Medicine, both in New Haven, Connecticut. Send correspondence to Dr. Mohr (e-mail: This research was supported by VA Health Services Research and Development (HSR&D) grant CRE 12-021 (Dr. Sayer, principal investigator). Dr. Kehle-Forbes was supported by a VA HSR&D Career Development Award (CDA 09-020). HSR&D was not involved in any aspect of the study’s design and conduct; data collection, management, analysis, or interpretation of data; or preparation, review, or approval of the manuscript. The findings and conclusions presented are those of the authors and do not necessarily represent the views of the VA or HSR&D.


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