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Background  Prolonged exposure therapy (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Standard workshop training in PE may not be sufficient to alter provider behavior, but post-workshop consultation requires significant resources. Therefore, it is important to determine the incremental utility of post-workshop consultation.    Methods  This study used a hybrid type III randomized implementation trial at 3 US Army installations. Providers were randomized to receive a 4-day prolonged exposure workshop (Standard training condition,  n  = 60), or the prolonged exposure workshop followed by 6–8 months of post-workshop expert case consultation (Extended training condition,  n  = 43). The effects training condition were examined on provider attitudes (self-efficacy in delivering PE, expectations for patient improvement, and beliefs about PE), use of PE and PE components, and clinical outcomes of patients with PTSD (using the Clinician-Administered PTSD Scale (CAPS-5)).    Results  Extended condition providers reported greater improvements in self-efficacy,  b  = .83, 95% CI [.38, 1.27],  t (79) = 3.71,  p  = .001, and  d  = .63. A greater proportion of patients in the Extended condition (44%) than in the Standard condition (27%) received at least 1 PE session,  b  = .76,  t (233) = 2.53,  p  = .012, and OR = 2.13. Extended condition providers used more PE components ( M  = .9/session) than did Standard condition providers ( M  = .5/session),  b  = .54, 95% CI [.15, .93],  t (68) = 2.70,  p  = .007, and  d  = .68. Finally, decrease in patients’ PTSD symptoms was faster for patients of Extended condition providers than for patients of Standard condition providers,  b  = − 1.81, 95% CI [− 3.57, − .04],  t (263) = − 2.02,  p  = .045, and  d  = .66, and their symptoms were lower at the second assessment,  b  = − 5.47, 95% CI [− 9.30, − 1.63],  t (210) = − 2.81,  p  = .005, and  d  = .66.    Conclusions  Post-workshop consultation improved self-efficacy for delivering PE, greater use of PE, faster PTSD reduction, and lower PTSD severity at the second assessment. To our knowledge, this is the first demonstration that post-workshop case consultation for PE improves patient outcomes.    Trial registration   Clinicaltrials.gov ,  NCT02982538 . Registered December 5, 2016; retrospectively registered

The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial