Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is expanding the use of a treatment for posttraumatic stress disorder, or PTSD, in six health systems.

PTSD is a mental health problem in which people relive trauma over and over again. People who have PTSD may have bad dreams or frightening thoughts. Treatments for PTSD can help improve patients’ mental health outcomes. But many people who have PTSD do not receive treatment. For some who do, the treatment they receive doesn’t meet their needs.

What is the goal of this implementation project?

A PCORI-funded systematic review update found good evidence about treatments that can reduce or stop PTSD symptoms. In one effective treatment, patients write about the thoughts and feelings they had at the time of their trauma. The writing occurs during five sessions with a trained mental health therapist, who checks in with the patient about challenges in completing the writing. This treatment is called Written Exposure Therapy, or WET.

This project is expanding the use of WET to improve mental health outcomes for patients with PTSD.

What will this project do?

The project team is working with six large, diverse health systems in nine states.

Health system staff are identifying patients with PTSD who may benefit from WET. They are using electronic health records and consulting a virtual data warehouse to identify patients with upcoming appointments. Clinicians, such as doctors and nurses, are also identifying eligible patients.

To support the sites in offering WET, the project team is:

  • Training mental health providers to deliver WET to their patients with PTSD in an online workshop.
  • Conducting site visits and refining plans for making WET a part of clinic processes at each site
  • Providing sites with ongoing support, including problem-solving advice from WET experts and feedback through monthly, online group learning sessions

The project team is also creating an online portal with resources for staff. These resources include a WET treatment manual, information sheets, communication scripts, and progress note templates. The portal also has a discussion forum and a feedback dashboard for clinicians.

After the project ends, clinicians will have access to ongoing consultation with WET experts from the PTSD Consultation Program. The program is part of the Department of Veterans Affairs’ National Center for PTSD.

The project team is developing a workbook to help other healthcare teams use WET.

What is the expected impact of this project?

The project will demonstrate what’s required to expand the use of WET in diverse health systems across the United States. About 400 mental health providers will be trained in WET, and about 1,600 patients will receive WET as part of their PTSD treatment. The project evaluation will confirm that WET is working as intended to improve mental health for patients with PTSD.

The health systems taking part in the project are members of the Mental Health Research Network, or MHRN. This network includes 14 large health systems across the United States. By taking part in the project, MHRN wants to extend the use of WET for PTSD throughout the network.

More about this implementation project:

Stakeholders Involved in This Project

  • Mental Health Research Network (MHRN)
  • Health Care Systems Research Network
  • Developers of the WET intervention
  • Department of Veterans Affairs’ National Center for PTSD

Implementation Strategies

  • Adapt the program to work with sites’ existing workflows, including refining site-specific implementation plans and developing different ways for sites to identify eligible patients.
  • Provide sites with tools to support implementation though an online clinician portal that includes the WET treatment manual, information sheets, communication scripts, and video demonstrations, as well as a discussion forum.
  • Train clinicians to deliver WET through an online workshop.
  • Conduct site visits.
  • Use a phased implementation approach.
  • Create a learning collaborative, facilitated by health system leaders and WET experts, to support use of WET at sites.
  • Provide technical assistance to sites, including individualized clinician telephone consultation with WET experts and ongoing practice facilitation and feedback through structured, online group learning sessions.
  • Partner with national stakeholder organizations to promote implementation.
  • Develop an implementation guide to support further use of the program at other sites.

Evaluation Outcomes

To document implementation:

  • Organizational readiness (survey)
  • Number and proportion of eligible clinicians trained and offering WET
  • Number and proportion of eligible patients (1) referred to and (2) receiving WET
  • Fidelity to the WET protocol (checklist)
  • Provider self-efficacy (survey)
  • Clinician and patient satisfaction (survey)
  • Maintenance

To assess healthcare and health outcomes:

  • Changes in patient PTSD symptoms, depression, and psychosocial functioning (survey)

Project Information

Joan Cook, PhD
Vanessa Simiola, PsyD
Yale University
Employing a Stepped-Wedge Design to Implement an Evidence-Based Psychotherapy for PTSD in Six Large, Diverse Health Care Systems

Key Dates

November 2022
September 2026


State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Project Details Type
Last updated: March 28, 2024