Project Design - A stepped wedge Sequential Multiple Assignment Randomized Trial (SMART) design will be used for this Type II Hybrid Effectiveness-Implementation project. The project will compare implementation outcomes (patient reach) of the standard VA implementation strategy to the implementation outcomes of the enhanced implementation strategy. This design will also allow us to document improvements in perceived access and PTSD outcomes for patients at sites that successfully implement the TOP intervention. The investigators will begin by collecting pre-implementation access and outcomes data from a sample of patients. In the first implementation step, all six VAMCs will conduct the standard VA implementation strategy at the selected CBOCs for nine months. At the end of the first implementation step, will collect follow-up data from the sample of patients to assess perceived access, intervention reach, and clinical effectiveness. To conduct the SMART trial design it will be necessary to specify a performance measure benchmark (i.e., tailoring variable) that will be used to determine whether the standard implementation effort is successful. The investigators will define implementation success based on the capacity of the full time care manager to enroll a prespecified number of patients. Specifically, the care manager will report the number of patients enrolled in the care management protocol to the evaluation team and implementation success will be defined as 50 enrolled patients over the 9 month period. If this performance measure benchmark is attained, the VAMC will discontinue the standard VA implementation efforts, but the investigators will continue to collect evaluation data. If the performance measure benchmark is not attained, the VAMC will be randomized to either continued standard VA implementation strategy or the enhanced implementation strategy in the next step. In the second implementation step, these VAMCs will conduct either the standard or enhanced implementation strategy at selected CBOCs for nine months. At the end of the second implementation step, the investigators will again collect follow-up data from the sample of patients to assess perceived access, intervention reach, and clinical effectiveness. If the performance measure benchmark is attained in the second step at standard or enhanced implementation sites, the VAMC will discontinue implementation efforts. If the performance measure benchmark is not attained at standard implementation sites, the VAMC will receive the enhanced implementation strategy in the next step. If the performance measure benchmark is not attained at enhanced implementation sites, the VAMC will continue to receive enhanced implementation. At the end of the third implementation step, the investigators will again collect follow-up data from the sample of patients to assess perceived access, intervention reach, and clinical effectiveness.