Scaling up the dissemination of evidence-based mental health practice to large systems and long-term time frames.

This Open Forum raises issues related to large-scale dissemination of sustainable evidence-based practices. Current dissemination efforts have been time limited and primarily conducted at volunteer sites with the skills of external expert trainers. The authors describe an effort to implement supported employment at 166 veterans programs in what is hoped to be a permanent addition to mental health services offered by the Department of Veterans Affairs. A two-stage process is described for developing a cadre of internal trainers who can realize the goals of this large-scale dissemination effort. Such strategies appear necessary to fully realize the broad national changes envisioned in the New Freedom Commission report.