Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative.

Abstract

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.

A Prospective Examination of Clinician and Supervisor Turnover Within the Context of Implementation of Evidence-Based Practices in a Publicly-Funded Mental Health System

“…These efforts include four specific initiatives: cognitive therapy (Stirman et al, 2010; Creed, Stirman, Evans, & Beck, 2014), prolonged exposure, trauma-focused cognitive behavioral therapy (Beidas et al, in review), and dialectical behavior therapy. A full-time city employee coordinates implementation, training, and ongoing consultation by treatment developers for each of the four initiatives.…”

System-Level Influences on the Sustainability of a Cognitive Therapy Program in a Community Behavioral Health Network

“…In 2007, the Beck Initiative (BI) was formed as a partnership between the Philadelphia Department of Behavioral Health and Intellectual disAbilities Services (DBHIDS) and the University of Pennsylvania (Penn) to implement, within the city’s behavioral health provider agencies, a CT program for depression and suicide prevention and for disorders that commonly co-occur with depression (13,14). DBHIDS is an urban mental health system with over 300 provider agencies that provide mental health and substance abuse services to the city’s 470,000 Medicaid recipients and thousands of uninsured and underinsured individuals (13,14).…”

“…DBHIDS is an urban mental health system with over 300 provider agencies that provide mental health and substance abuse services to the city’s 470,000 Medicaid recipients and thousands of uninsured and underinsured individuals (13,14). …”

“…Evidence that this program has been sustained includes continued funding, ongoing involvement among the majority of agencies that completed training, enrollment of new agencies, and expansions to offer CT to additional populations and settings (14). Also, although employee turnover affected sustainability at the clinic level, a high proportion of the clinicians who remained at their clinics two years after CT training in a community-based implementation program demonstrated sustained CT fidelity (Stirman SW, Pontoski K, Creed T, et al, unpublished manuscript, 2014).…”

The Measurement of Cognitive Schemas: Validation of the Psychological Distance Scaling Task in a Community Mental Health Sample

“…The validity of the PDST in African American/minority, low-income, and low-education samples has not been examined to date. Given the ongoing dissemination of cognitive therapy to community mental health settings that serve high proportions of low-income, low-education, and minority consumers (Creed et al, 2014), it is important to examine whether potential measures of constructs relevant to cognitive therapy perform with adequate psychometric properties in these settings and populations.…”