Problem-Solving Training for VA Integrated Primary Care Providers: Real-World Outcomes

Mental and behavioral health concerns are common among primary care patients, yet patients are often unwilling to seek specialty mental health services. Integrated primary care services offer the opportunity to improve access and engagement in care, effectively manage symptoms, and enhance prevention efforts. While evidence-based transdiagnostic interventions such as Problem-Solving Therapy have demonstrated effectiveness in managing many of the common mental and behavioral health concerns that primary care patients report, its format is incompatible with the brief, 1-to-1 care format typical of integrated primary care services. This article discusses the adaptation and implementation of a problem-solving treatment for the primary care setting used within the Department of Veterans Affairs. Results of a national program evaluation are presented using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) program evaluation framework. Findings indicated that 84.5% of providers who enrolled in Problem-Solving Training in Primary Care (PST-PC) completed the program, and 78.2% of veterans who received PST-PC during the observation period completed the full 4-session protocol. Statistically and clinically significant improvements were observed in depressive symptoms, suicidal ideation, general distress, and perceived resilience (Cohen's d range = 0.30-0.74) for the cohort of veterans who completed treatment. Exit survey responses showed that the protocol was well-received by both patients and providers, though modest evidence of long-term drift (e.g., inconsistent use of protocol handouts, use of protocol subcomponents vs. the full treatment course) emerged. Implications for future research and considerations to improve long-term fidelity and program sustainability are discussed.