Objective Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. Method Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians’ work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. Results Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). Conclusions Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. Public Health Significance Access to EBPs in community settings has been a long-sought but slow process, and the Beck Community Initiative suggests a practical model for EBP increasing access in a large CBH network.

In keeping with aspirational principles and adhering to the ethical standards of psychology, clinicians should strive to provide the highest possible quality of care and to represent their competencies accurately to potential clients. Yet how are clinicians to gauge their own competence in order to determine if they are adhering to these ethical standards and principles? Research suggests that, unfortunately, clinicians may not be the best reporters of their own abilities (Creed, Wolk, Feinberg, Evans, & Beck, 2016; Mathieson, Barnfield, & Beaumont, 2009). The current article discusses several possible explanations for this finding, including cognitive biases (e.g., better-than-average bias; J. D. Brown, 1986), therapist drift (Waller & Turner, 2016), and therapist burnout (Maslach, Schaufeli, & Leiter, 2001). Several approaches for improving clinicians’ self-awareness are discussed and practical suggestions are made. Benefits of peer consultation are highlighted, and strategies for identifying appropriate consultation group members and fostering vulnerability among members are encouraged. In addition, clinicians are urged to utilize objective tools for assessing therapeutic competence, including work sample review and outcome tracking measures. In each case, barriers to utilizing these tools and strategies to overcome these obstacles are addressed. Finally, the value of certification through an accredited body using blind, objective ratings of work products is discussed. These strategies are suggested to help improve clinician self-awareness, allowing for more accurate representation of clinical competencies, an important step toward improving access to quality health services for individuals seeking psychotherapy.

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Intake no-show rates for psychotherapy vary from 20% to 57% (Swenson & Pekarik, 1988), and experiential avoidance may be related to failure to attend intake sessions. This pilot study attempted to increase intake attendance at a community mental health center by employing a brief experiential acceptance-based intervention. Those who scheduled intakes were randomly assigned to 1 of 2 groups: orientation letter or acceptance-enhanced orientation letter; rates from these conditions were compared with a retrospective comparison control group. Participants were randomized by way of an online random number generator. Persons assigned to the orientation group did not have a higher show rate than persons within the control group (∼48% compared with ∼52%). Persons assigned to the acceptance group did have higher show rates than persons in the other two groups (∼67% compared with ∼48% and ∼52%, respectively), however this difference was nonsignificant. Results suggest that brief acceptance-based interventions should be further studied for their potential value in maximizing client attendance.

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