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Published Online: 5 November 2024

Clinic-Level Predictors of Psychotherapy Dosage in the Military Health System

Carmen P. McLean, Ph.D. [email protected], Chunki Fong, M.S., Christopher K. Haddock, Ph.D., Jeffrey Cook, Ph.D., Alan L. Peterson, Ph.D., David S. Riggs, Ph.D., Stacey Young-McCaughan, R.N., Ph.D., … Show All … , Allison M. Conforte, Ph.D., Araceli Flores, Ph.D., Jeremy Jinkerson, Ph.D., Zachary K. Jones, Ph.D., Hana J. Kim, Ph.D., Jared S. Link, Psy.D., Debra Nofziger, Psy.D., Erik N. Ringdahl, Ph.D., Craig Woodworth, Psy.D., Jeffrey McCullen, M.S., Emily Ho, M.S., and Craig S. Rosen, Ph.D. for the TACTICS Research GroupAuthors Info & Affiliations
Publication: Psychiatric Services
Preprint
https://doi.org/10.1176/appi.ps.20240180
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Abstract

Objective:

This study aimed to describe the demand for, supply of, and clinic processes associated with behavioral health care delivery in the Military Health System and to examine the clinic-level factors associated with receipt of a minimally adequate dosage of psychotherapy.

Methods:

This retrospective study used administrative behavioral health data from eight military treatment facilities (N=25,433 patients; N=241,028 encounters) that were participating in a larger implementation study of evidence-based psychotherapy for posttraumatic stress disorder. Minimally adequate dosage of psychotherapy was defined in two ways: at least three sessions within a 90-day period and at least six sessions within a 90-day period. The authors then used a path model to examine clinic-level factors hypothesized to predict psychotherapy dosage, including care demand, supply, and processes.

Results:

Patients had an average of 2.5 psychotherapy appointments per quarter. Wait times for intake, between intake and the first psychotherapy session, and between follow-up sessions all averaged 17 days or longer. Path modeling showed that a higher patient-to-encounter ratio was associated with a longer wait time between follow-up psychotherapy appointments. In turn, a longer wait time between appointments was associated with a lower probability of receiving an adequate dosage of psychotherapy. However, a greater proportion of care delivered in groups was associated with a greater probability of receiving at least six sessions of psychotherapy.

Conclusions:

Receipt of a minimally adequate dosage of psychotherapy in the Military Health System is hindered by clinic staffing and workflows that increase wait times between follow-up psychotherapy appointments.

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Information & Authors

Information

Published In

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Psychiatric Services
Preprint

History

Received: 14 April 2024
Revision received: 8 July 2024
Accepted: 22 August 2024
Published online: 5 November 2024

Keywords

  1. psychotherapy
  2. mental health systems/hospitals
  3. military health

Authors

Details

Carmen P. McLean, Ph.D. [email protected]
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
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Chunki Fong, M.S.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
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Christopher K. Haddock, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
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Jeffrey Cook, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
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Alan L. Peterson, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
David S. Riggs, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
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Stacey Young-McCaughan, R.N., Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Allison M. Conforte, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Araceli Flores, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
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Jeremy Jinkerson, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Zachary K. Jones, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Hana J. Kim, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Jared S. Link, Psy.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Debra Nofziger, Psy.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Erik N. Ringdahl, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Craig Woodworth, Psy.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Jeffrey McCullen, M.S.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Emily Ho, M.S.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
Craig S. Rosen, Ph.D.
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author
for the TACTICS Research Group
Dissemination and Training Division, National Center for PTSD, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (McLean, Rosen); Social Sciences Innovations, New York City (Fong, Haddock); Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda (Cook, Riggs, Nofziger); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (Cook, Nofziger); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson, Young-McCaughan); Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, Florida (Conforte, Kim); William Beaumont Army Medical Center, El Paso, Texas (Flores); 81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi (Jinkerson, Jones, Link); David Grant U.S. Air Force (USAF) Medical Center, Travis Air Force Base, Fairfield, California (Ringdahl); Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas (Woodworth); Enterprise Intelligence and Data Solutions, San Antonio, Texas (McCullen, Ho).
View all articles by this author

Notes

Send correspondence to Dr. McLean ([email protected]).

Competing Interests

Dr. McLean reports receiving royalties from the American Psychological Association and an honorarium from the Association for Behavioral and Cognitive Therapies. Dr. Peterson reports research funding from the Bob Woodruff Foundation and Texas Veterans and Family Alliance. Dr. Riggs reports ownership of stock in Johnson & Johnson and ownership of a health-related mutual fund. The other authors report no financial relationships with commercial interests.

Funding Information

This work was supported by the U.S. Department of Defense (DoD) through the U.S. Army Medical Research and Development Command, Congressionally Directed Medical Research Programs (grant W81XWH-17-C-0236). This material is the result of work supported with resources and the use of facilities at the VA Palo Alto Health Care System.The views expressed herein are solely those of the authors and do not reflect an endorsement by or the official policy or position of the Uniformed Services University of the Health Sciences, Henry M. Jackson Foundation for the Advancement of Military Medicine, Brooke Army Medical Center, U.S. Army Medical Department, Defense Health Agency, U.S. Army Office of the Surgeon General, Department of the Army, Department of the Air Force, Department of the Navy, DoD, VA, or the U.S. government.

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