Data Analysis - The stepped wedge SMART design allows us to estimate the effectiveness of the implementation strategy by comparing patient reach between groups of VAMCs randomized to standard or enhanced implementation and by comparing reach outcomes over time within the same VAMC as it is transitioned from standard implementation to enhanced implementation. Likewise, by collecting PCL-5 scores pre-baseline and again throughout each implementation step, the investigators will be able to compare access and PTSD outcomes of patients between VAMCs successfully implementing TOP to those not successfully implementing TOP and by comparing access and PTSD outcomes over time within the same VAMC as it is transitions from pre-implementation to successful implementation. This will allow us to estimate the clinical effectiveness of the TOP promising practices as implemented in routine care. Following intent to treat principals, the investigators will estimate the clinical effectiveness of TOP for the entire sample regardless of whether they were reached to generate a measure of population level effectiveness. Generalized linear models will be used to account for the clustering of patients and providers within VAMCs and CBOCs. VAMCs and CBOCs will specified as random effects and time period will be specified as a fixed effect. The reach, access and PTSD outcome regressions will be estimated using patients as the unit of analysis and data from all VAMCs will be included regardless of whether the VAMC attained the performance measure benchmark. For hypothesis 1 (reach regression), the explanatory variable will be whether the VAMC was randomized to standard VA implementation or enhanced implementation during each step. For hypothesis 2 (PTSD outcomes regression) and 3 (access regression), the explanatory variable will be whether the VAMC attained the performance measure benchmark during each time period. Using implementation and intervention cost data, the investigators will also calculate the population level cost-effectiveness of using the enhanced implementation strategy to deploy the TOP promising practice relative to the standard VA implementation strategy.