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

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. (PsycINFO Database Record

Brief acceptance-based intervention for increasing intake attendance at a community mental health center.

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.