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Maxwell CA, Ehrhart MG, Williams NJ, Moore TM, Kendall PC, Beidas RS. The Organizational Financial Context of Publicly-Funded Mental Health Clinics: Development and Preliminary Psychometric Evaluation of the Agency Financial Status Scales. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:780-792. [PMID: 33740163 DOI: 10.1007/s10488-021-01128-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
Funding is a major barrier to implementation of evidence-based practices (EBPs) in publicly-funded community mental health clinics (CMHCs). Understanding how best to deploy implementation strategies that address this barrier requires greater clarity on the financial context within agencies. We developed the Agency Financial Status Scales (AFSS) to assess employee perceptions of the level of three hypothesized and theoretical funding related constructs in organizations: (a) perceptions of financial health, (b) financial attitudes toward EBPs, and (c) strategic financial climate. This investigation serves as a preliminary evaluation of this measure. Participants were 239 therapists and 40 supervisors from 25 publicly-funded CMHCs providing outpatient mental health services for young people. Confirmatory factor analysis was used to investigate the latent trait structure of the items. Internal consistency, interrater agreement, concordance between therapists and supervisors, and convergent validity were also examined. A two-factor model measuring perceptions of financial health and strategic financial climate best fit the data. For both of these scales, alpha reliability was acceptable and agreement statistics provided moderate support for aggregation at the organizational level. Analyses supported the convergent validity of the scales. The development and preliminary evaluation of the AFSS is an important first step in understanding the financial context of publicly-funded CMHCs. Though findings from this investigation are promising, additional development and testing are needed to develop a more thorough understanding of the constructs and to improve the validity and reliability of this measure.
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Affiliation(s)
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, USA
| | | | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA
| | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA.
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Penn Implementation Science Center At the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
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When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven Implementation of Multiple EBPs for Children. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:323-337. [PMID: 31720914 DOI: 10.1007/s10488-019-00987-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Therapist discontinuation of delivering an evidence-based practice (EBP) is a critical outcome in the community implementation of EBPs. This mixed methods study examined factors associated with therapist discontinuation within a large reimbursement-driven implementation of multiple EBPs in public children's mental health services. The study integrated quantitative survey data from 748 therapists across 65 agencies, and qualitative interviews from a subset of 79 therapists across 14 agencies. Therapists adopted, on average, 2.41 EBPs (SD = 1.05, range = 1-5), and nearly half (n = 355, 47.5%) reported discontinuing at least one EBP. Multi-level models were used to predict the binary outcome of discontinuation, and qualitative analyses were used to expand upon quantitative findings. Quantitative models revealed that therapist factors, including fewer direct service hours per week, a greater number of EBPs adopted, higher emotional exhaustion, and more negative attitudes toward EBPs in general were associated with discontinuation. In addition, EBP-specific factors including more negative perceptions of the particular EBP and lower self-efficacy for delivering the specific EBP predicted discontinuation. Themes from interview responses highlighted the importance of fit of the EBP with the agency's client base, as well as therapist perceptions of adequate EBP training supports, and the alignment of an EBP with therapists' professional goals. Together, the findings suggest the need for strategic sustainment planning interventions that target EBP fit (i.e., fit between adopted EBPs and agency target population, fit between EBP and therapist preferences and career goals) and support therapist self-efficacy in delivering EBPs.
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Mallard Swanson K, Song J, Beristianos M, Aajmain S, Lane JE, Landy MS, Suvak MK, Shields N, Monson CM, Stirman SW. A Glimpse into the "Black Box": Which Elements of Consultation in an EBP are Associated with Client Symptom Change and Therapist Fidelity? IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211051791. [PMID: 37090000 PMCID: PMC9978606 DOI: 10.1177/26334895211051791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Consultation is an implementation strategy that improves delivery and clinical outcomes for Cognitive Processing Therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD). However, little is known about the specific components of consultation that influence the fidelity of treatment delivery or clinical outcomes. Methods: The current study examined whether specific activities performed during CPT consultation meetings were associated with better fidelity to the CPT protocol among 60 newly trained therapists or improved clinical outcomes among 135 clients treated by these therapists. Consultation activities that fall under three broad categories (discussion of the application of CPT to individual cases, review/feedback on fidelity, and technical difficulties) were measured by consultant checklists for each consultation session. Treatment fidelity (adherence to the protocol and competence of delivery) was rated by trained observers for a random sample of therapists' CPT sessions following consultation. The self-reported PTSD Checklist-IV assessed PTSD symptom change. Results: Multilevel regression analyses indicated that higher therapist consultation attendance predicted a greater decrease in their clients' PTSD symptoms and that attendance was not associated with observer-rated treatment fidelity. Discussion of the application of specific CPT strategies was the only consultation activity that was significantly associated with greater improvement in PTSD symptoms. Lastly, no consultation activities were significantly associated with treatment fidelity. Conclusions: Our findings suggest that specific consultation strategies such as emphasizing the discussion of the application of specific CPT strategies to individual cases during consultation meetings may be effective in improving the clinical outcomes of CPT.
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Affiliation(s)
| | - Jiyoung Song
- National Center for PTSD and Stanford University, Menlo Park, CA,
USA
| | | | - Syed Aajmain
- National Center for PTSD and Stanford University, Menlo Park, CA,
USA
| | - Jeanine E.M. Lane
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Norman Shields
- Royal Canadian Mounted
Police, Divisional Psychologist Occupational Health and Safety
Services, Ottawa, Ontario, Canada
| | - Candice M. Monson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Montgomery GH, Green JP, Erblich J, Force J, Schnur JB. Common paraverbal errors during hypnosis intervention training. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2021; 63:252-268. [PMID: 33617422 DOI: 10.1080/00029157.2020.1822275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is growing literature to support the use of hypnosis as an evidence-based behavioral medicine intervention to manage a wide variety of symptoms and side effects associated with cancer and its treatment (e.g., pain, nausea, fatigue). However, formal training in hypnosis is often lacking among cancer care providers. The purpose of this study is to identify common paraverbal errors among hypnosis trainees in order to inform future training efforts. In a sample of 196 hypnosis trainees, paraverbal errors (i.e., tone, pacing, and phrasing) were tracked across hypnotic intervention components. Results revealed that trainees had most difficulty with hypnotic tone, particularly during the Induction, Deepening, and Alerting components. Individual trainee characteristics were unrelated to paraverbal errors.
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Affiliation(s)
| | | | - Joel Erblich
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James Force
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Gumport NB, Yu SH, Harvey AG. Implementing a transdiagnostic sleep and circadian intervention in a community mental health setting: A qualitative process evaluation with community stakeholders. Psychiatry Res 2020; 293:113443. [PMID: 32890862 DOI: 10.1016/j.psychres.2020.113443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
The implementation of evidence-based psychological treatments (EBPTs) may be particularly challenging to accomplish in community mental health settings for individuals with severe mental illness (SMI). Transdiagnostic treatments, or treatments that target a mechanism that underpins multiple mental health problems, may be particularly well-suited to community mental health settings. This study examines community stakeholder perspectives (N = 22) of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) implemented in a community mental health setting in the context of a randomized controlled trial of TranS-C for SMI. The present study aimed to identify barriers and facilitators to the implementation of TranS-C for SMI in a community mental health setting using (1) a deductive theory-based process based on the Framework for Dissemination in Health Services Intervention Research and (2) an inductive thematic analysis process. All deductive themes were identified as both barriers and facilitators to the implementation of EBPTs and TranS-C in this community mental health setting. Seven additional themes were identified through the inductive thematic analysis. A discussion of how the findings are related to prior research, other EBPT implementation, and future TranS-C implementation are included.
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Affiliation(s)
- Nicole B Gumport
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States
| | - Stephanie H Yu
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States; Department of Psychology, University of California, Los Angeles, CA, United States
| | - Allison G Harvey
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States.
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Allchin B, Goodyear M, O'Hanlon B, Weimand BM. Leadership perspectives on key elements influencing implementing a family-focused intervention in mental health services. J Psychiatr Ment Health Nurs 2020; 27:616-627. [PMID: 32037644 DOI: 10.1111/jpm.12615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 01/09/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Family-focused interventions in Adult Mental Health Services (AMHS) address the needs of families where a parent is diagnosed with a mental illness. One of these interventions is the "Let's Talk about Children" programme (Let's Talk) (Solantaus & Toikka, 2006 International Journal of Mental Health Promotion, 8(3), 37). There is limited implementation knowledge on family-focused interventions. A body of research to better understand the transfer of evidence-based interventions into everyday practice has identified multiple influencing elements. The Consolidated Framework for Implementation Research (CFIR) has combined these known elements from research into five domains of influence. Elements that influence the implementation of evidence-based practice are inter-related and need to be understood in combination. Understanding different stakeholder perspectives on implementation in real-world settings helps to understand uptake, challenges and opportunities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: As the first study to document leadership's perspectives of implementing Let's Talk, this paper contributes to the evidence base on their role in implementing family-focused practice models in mental health. There are specific roles of leadership that need to be addressed to support implementing Let's Talk in changing environments. Leadership's knowledge of Let's Talk and approach to change influences implementation. Questions are raised about the role the readiness of the parent and the impact that the dynamic process between the practitioner and parent has on implementing Let's Talk. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Engaging leadership needs to address the influence of their different organizational roles in shaping implementation for Let's Talk. Further research is needed to understand the dynamic process between parent and practitioner that influences readiness for trialling Let's Talk. ABSTRACT: Introduction Different stakeholder's perspectives are needed to understand challenges and opportunities in implementing and sustaining evidence-based practices (EBP) in real-world settings. Aim/Question To identify leadership perspectives on key elements influencing the process of implementation of Let's Talk about Children (Let's Talk), a family-focused practice for practitioners working with parents diagnosed with a mental illness. Method Semi-structured interviews were conducted with 16 service managers and implementation leads, to establish their views on key elements influencing implementation of Let's Talk during a randomized controlled trial. A thematic analysis applied both inductive and deductive approaches, using the Consolidated Framework for Implementation Research (CFIR). Results Impacts to effective translation to practice were grouped into three broad themes with eight subthemes: inner and outer setting impacting organization, leadership affecting readiness and parent and practitioner readiness. Discussion The findings suggest that specific roles for leadership are vital to implementation within an environment of constant change, and more attention is needed to understand the dynamics of parent and practitioner readiness for delivering Let's Talk. Implications for practice Different leadership roles need to be engaged to sustain Let's Talk in changing real-world environments. The dynamic processes between parent and practitioner are suggested to influence readiness and need further research.
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Affiliation(s)
- Becca Allchin
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Clayton, Vic., Australia.,Eastern Health Mental Health Program, Melbourne, Vic., Australia
| | - Melinda Goodyear
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Clayton, Vic., Australia.,Emerging Minds, Hilton, SA, Australia
| | - Brendan O'Hanlon
- The Bouverie Centre, La Trobe University, Melbourne, Vic., Australia
| | - Bente M Weimand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,School of Nursing and Midwifery, Queens University Belfast, Belfast, Northern Ireland
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Stakeholder Preferences on Transdiagnostic Psychosocial Treatment for Trauma-Exposed Veterans. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:660-669. [PMID: 31187316 DOI: 10.1007/s10488-019-00948-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While modular and transdiagnostic approaches may address implementation challenges, there remains limited investigation into the fit within large healthcare systems. The current study examines qualitative interviews from patients, clinicians and administrative stakeholders in the Veterans Administration about experiences with, and views of, the Unified Protocol (UP; Barlow et al. in The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide, Oxford University Press, New York, 2011) to understand potential for implementation. Qualitative interviews were conducted based on an established implementation framework and speak to implementation of transdiagnostic treatment in veterans, including insight into barriers, facilitators, intervention characteristics, patient characteristics, and system level variables. The UP demonstrated promise for improving efficiency, satisfaction and personalizing mental healthcare.
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Jensen-Doss A, Smith AM, Becker-Haimes EM, Mora Ringle V, Walsh LM, Nanda M, Walsh SL, Maxwell CA, Lyon AR. Individualized Progress Measures Are More Acceptable to Clinicians Than Standardized Measures: Results of a National Survey. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:392-403. [PMID: 29143173 DOI: 10.1007/s10488-017-0833-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite research supporting measurement-based care grounded in standardized progress measures, such measures are underutilized by clinicians. Individualized measures of client-specific targets present an alternative, but little is known about their acceptability or use. We compared attitudes toward and use of standardized and individualized progress measures in a national sample of 504 clinicians. Clinicians reported neutral to positive attitudes toward both types of measures, but strongly preferred and were more likely to use individualized measures. Clinician attitudes, theoretical orientation, and work setting predicted assessment preferences and practices. Implications for dissemination and implementation of measurement-based care are discussed.
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Affiliation(s)
- Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
| | - Ashley M Smith
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.,University of California, Los Angeles, USA
| | | | - Vanesa Mora Ringle
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Lucia M Walsh
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Monica Nanda
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | | | - Colleen A Maxwell
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Lau AS, Gonzalez JC, Barnett ML, Kim JJ, Saifan D, Brookman-Frazee L. Community Therapist Reports of Client Engagement Challenges During the Implementation of Multiple EBPs in Children's Mental Health. ACTA ACUST UNITED AC 2018; 3:197-212. [PMID: 31263771 DOI: 10.1080/23794925.2018.1455545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study investigated therapist reports of client engagement challenges in delivering evidence-based practices (EBPs), within the context of a large-scale implementation of multiple practices in children's mental health services. Data were drawn from an online survey of 668 therapists (88% female, 35.0% Non-Hispanic White). The majority of therapists (75.4%) endorsed at least one client engagement challenge during their implementation of an EBP with an identified client over the previous two months. Two types of EBP client engagement challenges with distinct correlates but similar overall frequencies could be readily differentiated - Expressed Client Concerns and Limited Client Engagement in therapy activities. Limited Client Engagement were more commonly reported for clients with externalizing problems and by therapists with higher emotional exhaustion and negative perceptions of the specific EBP being delivered, whereas Hispanic/Latino therapists were less likely to report Limited Client Engagement. In contrast, Expressed Client Concerns were more commonly reported by therapists with positive general attitudes towards EBPs, and among therapists delivering a parent training EBP. Limited Client Engagement but not Expressed Concerns were linked with therapists' self-reported ability to carry out the EBP with the target client. Findings suggest that client engagement challenges are frequent during the delivery of EBPs, but may impact implementation differently based on whether they relate to challenges in engaging clients in therapy activities versus addressing concerns raised by clients.
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Affiliation(s)
- Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Juan Carlos Gonzalez
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Miya L Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Joanna J Kim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego, San Diego, CA, USA
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Beidas RS, Stewart RE, Adams DR, Fernandez T, Lustbader S, Powell BJ, Aarons GA, Hoagwood KE, Evans AC, Hurford MO, Rubin R, Hadley T, Mandell DS, Barg FK. A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:893-908. [PMID: 26658692 DOI: 10.1007/s10488-015-0705-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA.
| | - Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Danielle R Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Tara Fernandez
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Susanna Lustbader
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Byron J Powell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | | | - Arthur C Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, USA
| | - Matthew O Hurford
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, USA
- Community Behavioral Health, Philadelphia, USA
| | | | - Trevor Hadley
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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Waltman S, Hall BC, McFarr LM, Beck AT, Creed TA. In-Session Stuck Points and Pitfalls of Community Clinicians Learning CBT: Qualitative Investigation. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Wiltsey Stirman S, Finley EP, Shields N, Cook J, Haine-Schlagel R, Burgess JF, Dimeff L, Koerner K, Suvak M, Gutner CA, Gagnon D, Masina T, Beristianos M, Mallard K, Ramirez V, Monson C. Improving and sustaining delivery of CPT for PTSD in mental health systems: a cluster randomized trial. Implement Sci 2017; 12:32. [PMID: 28264720 PMCID: PMC5339953 DOI: 10.1186/s13012-017-0544-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/28/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavily in programs to implement EBPs, few eligible patients receive EBPs in routine care settings, and clinicians do not appear to deliver the full treatment protocol to many of their patients. Emerging evidence suggests that when CPT and other EBPs are delivered at low levels of fidelity, clinical outcomes are negatively impacted. Thus, identifying strategies to improve and sustain the delivery of CPT and other EBPs is critical. Existing literature has suggested two competing strategies to promote sustainability. One emphasizes fidelity to the treatment protocol through ongoing consultation and fidelity monitoring. The other focuses on improving the fit and effectiveness of these treatments through appropriate adaptations to the treatment or the clinical setting through a process of data-driven, continuous quality improvement. Neither has been evaluated in terms of impact on sustained implementation. METHODS To compare these approaches on the key sustainability outcomes and provide initial guidance on sustainability strategies, we propose a cluster randomized trial with mental health clinics (n = 32) in three diverse MHSs that have implemented CPT. Cohorts of clinicians and clinical managers will participate in 1 year of a fidelity oriented learning collaborative or 1 year of a continuous quality improvement-oriented learning collaborative. Patient-level PTSD symptom change, CPT fidelity and adaptation, penetration, and clinics' capacity to deliver EBP will be examined. Survey and interview data will also be collected to investigate multilevel influences on the success of the two learning collaborative strategies. This research will be conducted by a team of investigators with expertise in CPT implementation, mixed method research strategies, quality improvement, and implementation science, with input from stakeholders in each participating MHS. DISCUSSION It will have broad implications for supporting ongoing delivery of EBPs in mental health and healthcare systems and settings. The resulting products have the potential to significantly improve efforts to ensure ongoing high quality implementation and consumer access to EBPs. TRIAL REGISTRATION NCT02449421 . Registered 02/09/2015.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University Department of Psychiatry and Behavioral Sciences, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Erin P. Finley
- The University of Texas Health Science Center at San Antonio, Department of Psychiatry and Medicine, 7703 Floyd Curl Dr, San Antonio, TX 78229 USA
- South Texas Veterans Health Care System, 7400 Merton Minter St, San Antonio, TX 78229 USA
| | - Norman Shields
- Divisional Psychologist Occupational Health and Safety, Royal Canadian Mounted Police, 4225 Dorchester, Westmount, QC Canada
| | - Joan Cook
- Department of Psychiatry, Yale University, 950 Campbell Avenue, West Haven, CT 06516 USA
| | | | - James F. Burgess
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA 02215 USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Department of Veterans Affairs Boston Healthcare System, Boston, MA USA
| | - Linda Dimeff
- Evidence-Based Practice Institute, 3303 S Irving Street Seattle, Seattle, WA 91844 USA
| | - Kelly Koerner
- Evidence-Based Practice Institute, 3303 S Irving Street Seattle, Seattle, WA 91844 USA
| | - Michael Suvak
- Suffolk University, 73 Tremont Street, Boston, MA 01331 USA
| | - Cassidy A. Gutner
- National Center for PTSD, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130 USA
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118 USA
| | - David Gagnon
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA 02215 USA
| | - Tasoula Masina
- Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Matthew Beristianos
- National Center for PTSD and Palo Alto Veterans Institute of Research, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Kera Mallard
- National Center for PTSD and Palo Alto Veterans Institute of Research, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Vanessa Ramirez
- The University of Texas Health Science Center at San Antonio, Department of Psychiatry and Medicine, 7703 Floyd Curl Dr, San Antonio, TX 78229 USA
- South Texas Veterans Health Care System, 7400 Merton Minter St, San Antonio, TX 78229 USA
| | - Candice Monson
- Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
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Zubkoff L, Carpenter-Song E, Shiner B, Ronconi JM, Watts BV. Clinicians' Perception of Patient Readiness for Treatment: An Emerging Theme in Implementation Science? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:250-8. [PMID: 25735617 DOI: 10.1007/s10488-015-0635-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite a training program to help veterans administration (VA) clinicians implement evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), uptake has been limited. To understand clinicians' implementation challenges, we performed thematic analysis of semi-structured telephone interviews guided by the Promoting Action on Research Implementation in Health Services framework. Our sample included 22 psychotherapists in VA PTSD clinics in one region. We identified a theme not captured by our implementation framework: clinicians' perceptions about their patients' readiness for treatment. Clinician perception of patient readiness may be important to the uptake of EBPs and should be considered in mental health implementation work.
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Affiliation(s)
- Lisa Zubkoff
- White River Junction VA Medical Center, 215 N. Main Street (10A4B1), White River Junction, VT, 05009, USA. .,Geisel School of Medicine at Dartmouth, Hanover, NH, USA. .,VA National Center for Patient Safety, White River Junction, VT, USA.
| | | | - Brian Shiner
- White River Junction VA Medical Center, 215 N. Main Street (10A4B1), White River Junction, VT, 05009, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,VA National Center for Patient Safety, White River Junction, VT, USA
| | - Julia M Ronconi
- White River Junction VA Medical Center, 215 N. Main Street (10A4B1), White River Junction, VT, 05009, USA
| | - Bradley V Watts
- White River Junction VA Medical Center, 215 N. Main Street (10A4B1), White River Junction, VT, 05009, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,VA National Center for Patient Safety, White River Junction, VT, USA
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Stirman SW, Pontoski K, Creed T, Xhezo R, Evans AC, Beck AT, Crits-Christoph P. A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:55-66. [PMID: 26577646 PMCID: PMC5293547 DOI: 10.1007/s10488-015-0700-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A "gold standard" condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD and Department of Psychiatry and Behavioral Sciences, VA Palo Alto Healthcare System and Stanford University, 795 Willow Road (NC-PTSD), Menlo Park, CA, 94025, USA.
| | - Kristin Pontoski
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Torrey Creed
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Regina Xhezo
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA
| | - Arthur C Evans
- Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA
| | - Aaron T Beck
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA
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15
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Eiraldi R, Khanna MS, Jawad AF, Fishman J, Glick HA, Schwartz BS, Cacia J, Wandersman A, Beidas R. A hybrid effectiveness-implementation cluster randomized trial of group CBT for anxiety in urban schools: rationale, design, and methods. Implement Sci 2016; 11:92. [PMID: 27405587 PMCID: PMC4941021 DOI: 10.1186/s13012-016-0453-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022] Open
Abstract
Background Schools present a context with great potential for the implementation of psychosocial evidence-based practices. Cognitive behavioral therapy (CBT) is an evidence-based practice that has been found to be very effective in treating anxiety in various community settings, including schools. Friends for Life (FRIENDS) is an efficacious group CBT protocol for anxiety. Unfortunately, evidence-based practices for anxiety are seldom employed in under-resourced urban schools, because many treatment protocols are not a good fit for the urban school context or the population, existing behavioral health staff do not receive adequate training or support to allow them to implement the treatment with fidelity, or school districts do not have the resources to contract with external consultants. In our prior work, we adapted FRIENDS to create a more culturally sensitive, focused, and feasible CBT protocol for anxiety disorders (CBT for Anxiety Treatment in Schools (CATS)). Methods/design The aim of this 5-year study is to evaluate both the effectiveness of CATS for urban public schools compared to the original FRIENDS as well as compare the implementation strategies (train-the-trainer vs. train-the-trainer + ongoing consultation) by conducting a three-arm, parallel group, type 2 hybrid effectiveness-implementation trial in 18 K-8 urban public schools. We will also assess the cost-effectiveness and the mediators and moderators of fidelity. Ninety therapists, 18 agency supervisors, and 360 children will participate. The interactive systems framework for dissemination and implementation guides the training and support procedures for therapists and supervisors. Discussion This study has the potential to demonstrate that agency therapists and supervisors who have had little to no prior exposure to evidence-based practices (EBPs) can implement an anxiety disorder EBP with fidelity. Comparisons of the implementation strategies would provide large urban mental health systems with data to make decisions about the adoption of EBPs. Trial registration ClinicalTrials.gov, NCT02651402
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Affiliation(s)
- Ricardo Eiraldi
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Muniya S Khanna
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA
| | - Abbas F Jawad
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Henry A Glick
- Wharton School, University of Pennsylvania, 3620 Locust Walk, Philadelphia, PA, 19104, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk # 210, Philadelphia, PA, 19104, USA
| | - Billie S Schwartz
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA
| | - Jaclyn Cacia
- The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA
| | - Abraham Wandersman
- Department of Psychology, University of South Carolina-Columbia, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC, 29208, USA
| | - Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, USA
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16
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Marques L, Dixon L, Valentine SE, Borba CPC, Simon NM, Wiltsey Stirman S. Providers' perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training-practice gap. Psychol Serv 2016; 13:322-31. [PMID: 27281696 DOI: 10.1037/ser0000087] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study aims to elucidate relations between provider perceptions of aspects of the consolidated framework for implementation research (Damschroder et al., 2009) and provider attitudes toward the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semistructured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for cognitive processing therapy for posttraumatic stress disorder (Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes toward EBTs. Provider-identified client-level factors include the following: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area. (PsycINFO Database Record
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Affiliation(s)
- Luana Marques
- Department of Psychiatry, Massachusetts General Hospital
| | - Louise Dixon
- Department of Psychology, University of California, Los Angeles
| | | | | | - Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital
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17
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Ringle VA, Read KL, Edmunds JM, Brodman DM, Kendall PC, Barg F, Beidas RS. Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. Psychiatr Serv 2015; 66:938-45. [PMID: 25975886 PMCID: PMC4869696 DOI: 10.1176/appi.ps.201400134] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The study examined, from the perspective of therapists, the barriers to and facilitators in implementing cognitive-behavioral therapy (CBT) for anxious youths in community settings. METHODS Fifty therapists (43% of the original training sample of 115 providers) participated in a follow-up interview two years after training and consultation. They reported on barriers to and facilitators in implementation of CBT for youths with anxiety. RESULTS Qualitative analyses identified numerous barriers and facilitators, including client factors (for example, motivated clients facilitated the use of CBT, whereas clients with complex issues and numerous psychosocial stressors hindered its use), intervention factors (the structure of CBT helped facilitate its use for some providers, whereas others reported feeling constrained by such structure), and organizational factors (for example, the absence of support within one's institution served as a barrier, whereas supervision supporting the use of CBT facilitated implementation). CONCLUSIONS Findings of this implementation trial align with conceptual implementation frameworks and may guide the tailoring of future implementation efforts in order to overcome barriers and maximize facilitators.
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Affiliation(s)
- Vanesa A Ringle
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kendra L Read
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Julie M Edmunds
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Douglas M Brodman
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Philip C Kendall
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Frances Barg
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rinad S Beidas
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
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18
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Cook JM, Dinnen S, Coyne JC, Thompson R, Simiola V, Ruzek J, Schnurr PP. Evaluation of an implementation model: a national investigation of VA residential programs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 42:147-56. [PMID: 24817625 PMCID: PMC4240747 DOI: 10.1007/s10488-014-0555-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs' (VA) residential treatment programs were used to explore these issues regarding prolonged exposure (PE) and cognitive processing therapy (CPT) in VA residential PTSD programs. Several unique and some overlapping predictors emerged. Leadership was viewed as an influence on implementation for both CPT and PE, while a lack of dedicated time and resources was viewed as a deterrent for both. Compatibility of CPT with providers' existing practices and beliefs, the ability to observe noticeable patient improvement, a perceived relative advantage of CPT over alternative treatments, and the presence of a supportive peer network emerged as influential on CPT implementation. Leadership was associated with PE implementation. Implications for the design and improvement of training and implementation efforts are discussed.
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Affiliation(s)
- Joan M Cook
- Yale School of Medicine and National Center for PTSD, 950 Campbell Avenue, NEPEC/182, West Haven, CT, 06516, USA,
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19
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Edmunds JM, Read KL, Ringle VA, Brodman DM, Kendall PC, Beidas RS. Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety. Implement Sci 2014; 9:89. [PMID: 25030651 PMCID: PMC4223397 DOI: 10.1186/s13012-014-0089-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 06/27/2014] [Indexed: 12/03/2022] Open
Abstract
Background Questions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety. Methods Of the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes. Results Findings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes. Conclusions Sustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation.
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Beidas RS, Edmunds JM, Cannuscio CC, Gallagher M, Downey MM, Kendall PC. Therapists perspectives on the effective elements of consultation following training. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:507-17. [PMID: 23435832 PMCID: PMC3676714 DOI: 10.1007/s10488-013-0475-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists and the consultant, (2) authentic interactions around actual cases, and (3) the responsiveness of the consultant to the needs of individual therapists. Recommendations for the design of future consultation endeavors are offered.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA,
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Perspectives on Cognitive Therapy Training within Community Mental Health Settings: Implications for Clinician Satisfaction and Skill Development. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:391084. [PMID: 23056933 PMCID: PMC3465974 DOI: 10.1155/2012/391084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
Despite the mounting evidence of the benefits of cognitive therapy for depression and suicidal behaviors over usual care, like other evidence-based psychosocial treatments (EBTs), it has not been widely adopted in clinical practice. Studies have shown that training followed by intensive consultation is needed to prepare providers to an appropriate level of competency in complex, multisession treatment packages such as cognitive therapy. Given the critical role of training in EBT implementation, more information on factors associated with the success and challenges of training programs is needed. To identify potential reasons for variation in training outcomes across ten agencies in a large, urban community mental health system, we explored program evaluation data and examined provider, consultant, and training program administrator perspectives through follow-up interviews. Perceptions of cognitive therapy, contextual factors, and reactions to feedback on audio recordings emerged as broad categories of themes identified from interviews. These factors may interact and impact clinician efforts to learn cognitive therapy and deliver it skillfully in their practice. The findings highlight experiences and stakeholder perspectives that may contribute to more or less successful training outcomes.
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