Original Article

Administration and Policy in Mental Health and Mental Health Services Research

, Volume 40, Issue 4, pp 274-285

First online:

Clinicians’ Perspectives on Cognitive Therapy in Community Mental Health Settings: Implications for Training and Implementation

  • Shannon Wiltsey StirmanAffiliated withWomen’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare SystemDepartment of Psychiatry, Boston University Email author 
  • , Ana Gutiérrez-ColinaAffiliated withDepartment of Psychology, University of Georgia
  • , Katherine ToderAffiliated withDepartment of Psychiatry, University of Pennsylvania
  • , Gregory EspositoAffiliated withUniversity of Pennsylvania
  • , Frances BargAffiliated withDepartment of Family Medicine and Community Health, School of Medicine, University of PennsylvaniaDepartment of Anthropology, University of Pennsylvania
  • , Frank CastroAffiliated withWomen’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare SystemDepartment of Psychiatry, Boston University
  • , Aaron T. BeckAffiliated withDepartment of Psychiatry, University of Pennsylvania
  • , Paul Crits-ChristophAffiliated withDepartment of Psychiatry, University of Pennsylvania

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Abstract

Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings.

Keywords

Evidence-based psychosocial treatments Cognitive therapy Dissemination and implementation