Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS) to Increase Evidence-Based Psychotherapy in Military Behavioral Health Clinics

This study introduces the TACTICS (Targeted Assessment and Context-Tailored Implementation of Change Strategies) framework, designed to enhance the adoption of evidence-based psychotherapies (EBPs) in military behavioral health clinics. Through a cluster-randomized stepped-wedge implementation trial, the study evaluates the effectiveness of TACTICS in improving the delivery of EBPs for mental health disorders in military settings.

The study design incorporates a robust implementation framework:

• Military behavioral health clinics were organized into clusters and randomized to different implementation time points.
• TACTICS involved targeted assessments of clinic-specific barriers and tailored implementation strategies to address these challenges.
• The study followed a stepped-wedge cluster-randomized design, where clinics transitioned to the intervention phase in a staggered manner.
• The primary focus was on the uptake and sustained use of evidence-based psychotherapies, along with secondary outcomes such as patient outcomes and provider attitudes.

This study highlights:

• TACTICS emphasizes tailoring strategies to the unique context of each clinic, addressing barriers to EBP adoption.
• This approach allows for systematic evaluation of implementation strategies across diverse settings while maintaining control over confounding variables.

The TACTICS framework offers a promising model for improving mental health care delivery in military settings. Key takeaways for providers and policymakers include:

• The importance of context-tailored interventions to address clinic-specific barriers to EBP adoption.
• The potential of stepped-wedge designs for evaluating implementation strategies in real-world healthcare settings.
• The need for ongoing support and adaptation to sustain the use of EBPs in military behavioral health clinics.

By focusing on tailored approaches and rigorous evaluation, TACTICS aims to enhance the quality of care for service members and improve mental health outcomes in military populations.