Papers by Allison Pulgarin Rodriguez
Translational behavioral medicine, Dec 6, 2017
National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administr... more National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administration (VHA) provides important lessons on the barriers and facilitators to implementation in a large healthcare system. Little is known about barriers and facilitators to the implementation of a complex EBP for emotional and behavioral dysregulation-dialectical behavioral therapy (DBT). The purpose of this study was to understand VHA clinicians' experiences with barriers, facilitators, and benefits from implementing DBT into routine care. This national program evaluation survey measured site characteristics of VHA sites (N = 59) that had implemented DBT. DBT was most often implemented in general mental health outpatient clinics. While 42% of sites offered all four modes of DBT, skills group was the most frequently implemented mode. Fifty-nine percent of sites offered phone coaching in any form, yet only 11% of those offered it all the time. Providers were often provided little to no ...
Implementation Science, 2016
Background Many cancer survivors with anxiety and depression symptoms are treated in oncology car... more Background Many cancer survivors with anxiety and depression symptoms are treated in oncology care settings that lack systems to recognize such symptoms or offer behavioral interventions. Materials and methods Over the past four years we have fostered a collaboration with the administrators, providers, and patients at a 21-office community oncology care network to address this challenge. We initially targeted a network office site and provider team that championed external collaborations, to establish screening procedures and conduct a pilot study. Results We aligned our goal to implement a screener for anxiety and depression symptoms among cancer survivors with the site's goal to implement a distress screener at survivorship appointments (N > 200 screened to date). Upon establishing a successful screening system, we partnered with an onsite social worker champion (J.L.M.) to develop and evaluate a behavioral intervention for positively screened patients (N = 51), in a format and length adapted to the needs of the site, with content iteratively refined in response to patient feedback. The intervention showed large effects on anxiety and depression outcomes. We communicated these findings to much of the network, thus building support from network administrative, physician, and social work teams to identify anxious and depressed patients, implement the intervention, and recently, to conduct a funded clinical trial in the network, using patient screening and recruitment strategies tailored to the needs and capacities of each site. Conclusions Our work demonstrates one approach to partnering with a communitybased cancer care network to implement a behavioral intervention that addresses anxiety and depression among cancer survivors. A8 Tailoring a Cognitive Behavioral Therapy implementation protocol using mixed methods, conjoint analysis, and implementation teams
Implementation Science, 2015
Background: With the current funding climate and need for advancements in implementation science,... more Background: With the current funding climate and need for advancements in implementation science, there is a growing demand for grantsmanship workshops to increase the quality and rigor of proposals. A group-based implementation science-focused grantsmanship workshop, the Implementation Development Workshop (IDW), is one methodology to address this need. This manuscript provides an overview of the IDW structure, format, and findings regarding its utility. Results: The IDW methodology allows researchers to vet projects in the proposal stage in a structured format with a facilitator and two types of expert participants: presenters and attendees. The presenter uses a one-page handout and verbal presentation to present their proposal and questions. The facilitator elicits feedback from attendees using a format designed to maximize the number of unique points made. After each IDW, participants completed an anonymous survey assessing perceptions of the IDW. Presenters completed a funding survey measuring grant submission and funding success. Qualitative interviews were conducted with a subset of participants who participated in both delivery formats. Mixed method analyses were performed to evaluate the effectiveness and acceptability of the IDW and compare the delivery formats. Of those who participated in an IDW (N = 72), 40 participated in face-to-face only, 16 in virtual only, and 16 in both formats. Thirty-eight (face-to-face n = 12, 35 % response rate; virtual n = 26, 66.7 % response rate) responded to the surveys and seven (15.3 % response rate), who had attended both formats, completed an interview. Of 36 total presenters, 17 (face-to-face n = 12, 42.9 % response rate; virtual n = 5, 62.9 % response rate) responded to the funding survey. Mixed method analyses indicated that the IDW was effective for collaboration and growth, effective for enhancing success in obtaining grants, and acceptable. A third (35.3 %) of presenters ultimately received funding for their proposal, and more than 80 % of those who presented indicated they would present again in the future. The IDW structure and facilitation process were found to be acceptable, with both formats rated as equally strong. Conclusions: The IDW presents an acceptable and successful methodology for increasing competitiveness of implementation science grant proposals.
Medical care, 2015
Patient-centered access to mental health describes the fit between patient needs and resources of... more Patient-centered access to mental health describes the fit between patient needs and resources of the system. To date, little data are available to guide implementation of services to women veterans, an underrepresented minority within Department of Veteran Affairs (VA) health care. The current study examines access to mental health care among women veterans, and identifies gender-related indicators of perceived access to mental health care. A population-based sample of 6287 women veterans using VA primary care services participated in a survey of past year perceived need for mental health care, mental health utilization, and gender-related mental health care experiences. Subjective rating of how well mental health care met their needs was used as an indicator of perceived access. Half of all women reported perceived mental health need; 84.3% of those women received care. Nearly all mental health users (90.9%) used VA services, although only about half (48.8%) reported that their me...
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Papers by Allison Pulgarin Rodriguez