Implementing Evidence-Based Mental-Health Treatments: Attending to Training, Fidelity, Adaptation, and Context

Abstract

This article provides a very high-level overview of some key considerations in the field of implementation science as it relates to clinical psychology. The article reviews recent findings regarding treatment fidelity, adaptation of treatments, and clinical outcomes. It then details some recent findings on training therapists to provide evidence-based therapies as they were designed to be delivered, with sufficient skill and adaptations if needed to ensure better fit for clients who receive treatments in different treatment settings. Finally, the article considers implications for implementing and sustaining new treatments and supporting their fidelity and adaptation, as well as key directions for future research.

Engaging stakeholders to inform national implementation of critical time intervention in a program serving homeless-experienced Veterans

“…These efforts can enable greater fidelity and sustainment, as well as effectiveness, in larger implementation initiatives. Though the implementation of EBPs requires a careful balance between tailoring interventions to contexts and maintaining fidelity to an EBP's core components (Von Thiele Schwarz et al, 2021 ; Wiltsey Stirman, 2022 ), we highlight the value of pilot work that tailors and enhances EBP training, technical assistance, and implementation supports to reflect relevant contextual factors.…”

Large language models could change the future of behavioral healthcare: A proposal for responsible development and evaluation

“…Measuring Treatment Fidelity. Finally, a clinical LLM application could automate measurement of therapist fidelity to evidence-based treatments (Table 2, bottom row), which typically includes measuring adherence to the treatment as designed and competence in delivering a specific therapy skill (Wiltsey Stirman, 2022). Measuring fidelity is crucial to the development, testing, dissemination, and implementation of evidence-based treatments, yet can be resource intensive and difficult to do reliably.…”

What role can (and should) clinical science play in promoting mental health care equity?

“…From an equity perspective, this directionality in the scientific focus is paramount; if adoption and dissemination of our EBTs (and their cultural adaptations) have been low in diverse community settings and the treatment adaptation frameworks are inconsistently applied using sound CBPR principles, what can we gain from empowering the community to choose their own focus for mental health intervention and most acceptable means to address these concerns? From this perspective, implementation science (IS) approaches have a lot to offer to address mental health care inequities (Beidas et al, 2013), given their focus on the critical examination of broader care systems, workforces, treatment fidelity, and specific elements/implementation of treatment adaptations that are key to uptake, adoption, maintenance, and acceptability of our interventions and clinical procedures for mental health (e.g., Wiltsey Stirman, 2022). For instance, Cabassa and Baumann (2013) have specifically examined how IS approaches can be integrated into cultural adaptations of treatment to improve their potency and prevent some of the issues of adoption and sustainability that have continued to haunt mental health treatment work in community settings.…”

“…We have seen this to be certainly true in a number of our own studies with local communities, who themselves highlight how they wish to see more capacity-building in mental health services by training people they trust within their own groups (e.g., Asnaani et al, in press; Kaur et al, 2022), and via our current involvement with state governments of health, where we provide brief but low-cost/free trainings to CHWs already embedded in racially/ethnically, socioeconomically and geographically diverse communities. Such a focus on task-shifting efforts makes a lot of sense within the dissemination and implementation framework of clinical science (Beidas et al, 2013; Wiltsey Stirman, 2022), given that our historical track record of promoting the adoption of EBTs and clinical science findings has clearly proven to be deficient and potentially contributed to ongoing mental health care inequities. Indeed, those working in this area have recognized that, again, integration of IS approaches within task-shifting efforts is essential to improving and scaling up such efforts, as we need more examination into how partnering with LHWs/CHWs can be most effectively done to appreciably improve the reach and effectiveness of our mental health interventions in communities experiencing the highest rates of care inequity (Barnett et al, 2019).…”

“…Indeed, this cross-disciplinary effort is highlighted in the IS approaches mentioned previously (Beidas et al, 2013), given its high relevance to the promotion of mental health care equity. While I have not focused extensively on the immense contribution of IS to clinical science in this article, its impact on the field cannot be understated, and many of the content areas reviewed are directly tied to its core principles (such as the importance of cross-disciplinary collaborations, the impact of task-shifting, and influencing structural/systemic policy change; Wiltsey Stirman, 2022). For instance, a growing body of work has been examining the integration of SSIs into mental health care systems to reduce barriers of cost and time burden on those seeking mental health solutions and to address our greatly overburdened mental health workforce (which cannot be adequately addressed completely with the task-shifting efforts of the field described previously).…”