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With a focus on two large, integrated health care systems (Military Health System, Veterans Health Administration), we discuss the challenges to scaling up access to EBPs for PTSD, as well as proposed strategies to mitigate these challenges. We identify three primary barriers to delivery of EBPs for PTSD: insufficient staffing, difficulty connecting patients with EBP\u2010trained providers, and structural inefficiencies characteristic of the weekly therapy model. We review emerging strategies to redesign the delivery of EBPs for PTSD, including accelerated delivery formats, alternative delivery settings, task\u2010sharing, web\u2010 and app\u2010based interventions, and the use of artificial intelligence. Taken together, these strategies represent promising opportunities to efficiently use limited staffing to increase access to EBPs for PTSD, while retaining or increasing intervention effectiveness. Further research is needed to determine how to most effectively integrate these strategies into a stepped\u2010care model of treatment delivery, where redesigned approaches complement traditional EBP delivery models to address the real\u2010world constraints of health care systems.<\/jats:p>","DOI":"10.1002\/jts.70090","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:00:56Z","timestamp":1781071256000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Redesigning trauma\u2010focused interventions to address capacity challenges in mental health systems"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4322-9318","authenticated-orcid":false,"given":"Carmen P.","family":"McLean","sequence":"first","affiliation":[{"name":"National Center for PTSD, Dissemination and Training Division Palo Alto VA Health Care System  Palo Alto California USA"},{"name":"Department of Psychiatry and Behavioral Sciences, School of Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5440-3698","authenticated-orcid":false,"given":"Nicholas","family":"Holder","sequence":"additional","affiliation":[{"name":"Mental Health Service, San Francisco VA Health Care System  San Francisco California USA"},{"name":"Department of Psychiatry and Behavioral Sciences University of California San Francisco School of Medicine  San Francisco California USA"},{"name":"Center for Data to Discovery and Delivery Innovation (3DI) San Francisco VA Health Care System  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9896-1904","authenticated-orcid":false,"given":"Ryan","family":"Holliday","sequence":"additional","affiliation":[{"name":"Research Service, VA Pacific Islands Health Care System  Honolulu, Hawaii USA"},{"name":"Research Service, VA Eastern Colorado Health Care System  Aurora Colorado USA"},{"name":"Departments of Psychiatry University of Colorado Anschutz Medical Campus  Aurora Colorado USA"},{"name":"Department of Physical Medicine and Rehabilitation University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4493-9066","authenticated-orcid":false,"given":"Craig S.","family":"Rosen","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Dissemination and Training Division Palo Alto VA Health Care System  Palo Alto California USA"},{"name":"Department of Psychiatry and Behavioral Sciences, School of Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005\u20107967(03)00138\u20104"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0036183"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcpy.1393"},{"key":"e_1_2_10_5_1","unstructured":"Defense Health Agency. 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