Implementing brief behavioral treatment for insomnia in Department of Veterans Affairs Primary Care Mental Health Integration clinics: Reach outcomes from a hybrid type 3 effectiveness-implementation trial

Abstract

Chronic insomnia is one of the most common health problems among veterans and can significantly impact health, function, and quality of life. Brief behavioral treatment for insomnia (BBTI), an adaptation of cognitive behavioral therapy for insomnia (CBT-I), was developed to help increase access to care outside of specialty settings. However, training providers alone is rarely sufficient, and implementation strategies are needed for successful uptake, adoption, and sustainable delivery of care. The current analysis compares the impact of providing BBTI training alone (BBTI) versus training plus implementation strategies (BBTI + IS) on veteran engagement in BBTI (i.e., reach) in Primary Care Mental Health Integration clinics. Providers from four Veterans Affairs (VA) medical centers completed BBTI training and then were given access to and support for implementation strategies. Core strategies implemented across all sites included developing an implementation blueprint, organizing implementation and educational meetings, developing and distributing educational materials, developing tools for quality monitoring, and facilitation. Veteran engagement in BBTI, CBT-I, insomnia diagnoses, and prescription sleep medication was measured using retrospective data from the VA Corporate Data Warehouse. Analyses were conducted using generalized linear models. Overall, sites significantly increased veteran engagement in BBTI (reach) from training alone and achieved further engagement with implementation strategies. At the site level, there was variability by phase, with three sites increasing BBTI only with training and one site increasing BBTI with training plus implementation support. These results are promising-increasing access to evidence-based behavioral insomnia care can be accomplished via BBTI training and easily implementable strategies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT04350866.