School Mental Health

, Volume 4, Issue 4, pp 197–206 | Cite as

Training School Mental Health Providers to Deliver Cognitive-Behavioral Therapy

  • Rinad S. Beidas
  • Matthew P. Mychailyszyn
  • Julie M. Edmunds
  • Muniya S. Khanna
  • Margaret Mary Downey
  • Philip C. Kendall
Original Paper


Anxiety disorders are among the most prevalent mental health difficulties experienced by youth. A well-established literature has identified cognitive-behavior therapy (CBT) as the gold-standard psychosocial treatment for youth anxiety disorders. Access to CBT in community clinics is limited, but a potential venue for the provision of CBT for child anxiety disorders is the school setting. The present study examined a subset of data from a larger study in which therapists from a variety of settings, including schools, were trained in CBT for child anxiety (N = 17). The study investigated the relationship between provider- and organizational-level variables associated with training and implementation among school mental health providers. The present findings indicate a positive relationship between provider attitudes and adherence to CBT. Self-reported barriers to implementation were also identified. Integrating CBT into school mental health providers’ repertoires through training and consultation is a critical step for dissemination and implementation of empirically supported psychosocial treatments.


Empirically supported treatments Cognitive-behavioral therapy Child and adolescent anxiety School mental health Training 



Research supported by National Institute of Mental Health Grants F31MH083333 awarded to Rinad Beidas and Philip Kendall.


  1. Aarons, G. A. (2005). Measuring provider attitudes toward evidence-based practice: Consideration of organizational context and individual differences. Child and Adolescent Psychiatric Clinics of North America, 14, 255–271. doi: 10.1016/j.chc.2004.04.008.PubMedCrossRefGoogle Scholar
  2. Aarons, G. A., & Sawitzky, A. C. (2006). Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological Services, 3, 61–72. doi: 10.1037/1541-1559.3.1.61.PubMedCrossRefGoogle Scholar
  3. Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Anxiety Disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (2nd ed., pp. 279–329). New York: The Guilford Press.Google Scholar
  4. Beidas, R. S., Barmish, A. J., & Kendall, P. C. (2009). Training as usual: Can therapist behavior change after reading a manual and attending a brief workshop on cognitive behavioral therapy for youth anxiety? The Behavior Therapist, 32, 97–101. Retrieved from
  5. Beidas, R. S., Edmunds, J. E., Marcus, S. C., & Kendall, P. C. (in press). An RCT of training and consultation as implementation strategies for an empirically supported treatment. Psychiatric Services.Google Scholar
  6. Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17, 1–30. doi: 10.1111/j.1468-2850.2009.01187.x.CrossRefGoogle Scholar
  7. Benjamin, C., Beidas, R., Edmunds, J., Cohen, J., & Kendall, P. (2010). Identification and treatment of anxious youth. Unpublished instrument. Google Scholar
  8. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.Google Scholar
  9. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: controversies and evidence. Annual Review of Psychology, 52, 685–716. doi: 10.1146/annurev.psych.52.1.685.PubMedCrossRefGoogle Scholar
  10. Costello, J. E., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844. doi: 10.1001/archpsyc.60.8.837.PubMedCrossRefGoogle Scholar
  11. Davy, L., Gantwerk, B., & Martz, S. (2009). Commissioner’s annual report to the education committees of the senate and general assembly on violence. Trenton, NJ: Vandalism and Substance Abuse in New Jersey Public Schools.Google Scholar
  12. Dimeff, L. A., Koerner, K., Woodcock, E. A., Beadnell, B., Brown, M. Z., Skutch, J. M., et al. (2009). Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills. Behavior Research and Therapy, 47, 921–930. doi: 10.1016/j.brat.2009.07.011.CrossRefGoogle Scholar
  13. Farmer, E. M., Burns, B. J., Philips, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54, 60–66. doi: 10.1176/ Scholar
  14. Fisher, P., Masia-Warner, C., & Klein, R. (2004). Skills for social and academic success: A school-based intervention for social anxiety disorder in adolescents. Clinical Child and Family Psychology Review, 7, 241–249.PubMedCrossRefGoogle Scholar
  15. Fixsen, D., Naoom, S. F., Blase, D. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, Florida. Retrieved from
  16. Flaherty, L. T., Weist, M. D., & Warner, B. S. (1996). School-based mental health services in the United States: History, current models and needs. Community Ment Health Journal, 32, 341–352.CrossRefGoogle Scholar
  17. Forman, S., Olin, S., Hoagwood, K., Crowe, M., & Saka, N. (2009). Evidence-based intervention in schools: Developers’ views of implementation barriers and facilitators. School Mental Health, 1, 26–36. doi: 10.1007/s12310-008-9002-5.CrossRefGoogle Scholar
  18. Garland, A. F., Brookman-Frazee, L., Hurlburt, M. S., Accurso, E. C., Zoffness, R. J., Haine-Schlagel, R., et al. (2010). Mental health care for children with disruptive behavior problems: a view inside therapists’ offices. Psychiatric Services, 61, 788–795. doi: 10.1176/ Scholar
  19. Ginsburg, G., Becker, K. D., Kingery, J. N., & Nichols, T. (2008). Transporting CBT for childhood anxiety disorders into inner-city school-based mental health clinics. Cognitive and Behavioral Practice, 15, 148–158. doi: 10.1016/j.cbpra.2007.07.001.CrossRefGoogle Scholar
  20. Glisson, C., & Green, P. (2011). Organizational climate, services, and outcomes in child welfare systems. Child Abuse and Neglect, 35, 582–591. doi: 10.1016/j.chiabu.2011.04.009.PubMedCrossRefGoogle Scholar
  21. Glisson, C., & James, L. R. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23, 767–794. doi: 10.1002/job.162.CrossRefGoogle Scholar
  22. Glisson, C., Schoenwald, S. K., Hemmelgarn, A., Green, P., Dukes, D., Armstrong, K. S., et al. (2010). Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78, 537–550. doi: 10.1037/a0019160.PubMedCrossRefGoogle Scholar
  23. Henggeler, S. W., Chapman, J. E., Rowland, M. D., Halliday-Boykins, C. A., Randall, J., Shackelford, J., et al. (2008a). Statewide adoption and initial implementation of contingency management for substance-abusing adolescents. Journal of Consulting and Clinical Psychology, 76, 556–567. doi: 10.1037/0022-006X.76.4.556.PubMedCrossRefGoogle Scholar
  24. Henggeler, S. W., Sheidow, A. J., Cunningham, P. B., Donohue, B. C., & Ford, J. D. (2008b). Promoting the implementation of an evidence-based intervention for adolescent marijuana abuse in community settings: testing the use of intensive quality assurance. Journal of Clinical Child and Adolescent Psychology, 37, 682–689. doi: 10.1080/15374410802148087.PubMedCrossRefGoogle Scholar
  25. Henry, W. P., Schacht, T. E., Strupp, H. H., Butler, S. F., & Binder, J. L. (1993). Effects of training in time-limited dynamic psychotherapy: Mediators of therapists’ responses to training. Journal of Consulting and Clinical Psychology, 61, 441–447.PubMedCrossRefGoogle Scholar
  26. Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30(4), 448–466. doi: 10.1016/j.cpr.2010.02.005.PubMedCrossRefGoogle Scholar
  27. Ialongo, N. S., Edelsohn, G., Werthamer-Larsson, L., Crockett, L., & Kellam, S. (1995). The significance of self-reported anxious symptoms in first grade children: Prediction to anxious symptoms and adaptive functioning in fifth grade. Journal of Child Psychology and Psychiatry, 36, 427–437.PubMedCrossRefGoogle Scholar
  28. Jaycox, L., Stein, B., Paddock, S., Miles, J. N., Chandra, A., Meredith, L. S., et al. (2009). Impact of teen depression on academic, social, and physical functioning. Pediatrics, 124, e596–e605. doi: 10.1542/peds.2008-3348.PubMedCrossRefGoogle Scholar
  29. Kendall, P. C., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. Journal of Consulting and Clinical Psychology, 72, 276–287. doi: 10.1037/0022-006X.72.2.276.PubMedCrossRefGoogle Scholar
  30. Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health srograms in schools: Barriers and facilitators of successful implementation. School Ment Health, 2, 105–113. doi: 10.1007/s12310-010-9038-1.PubMedCrossRefGoogle Scholar
  31. Lehman, W., Greener, J., & Simpson, D. (2002). Assessing organizational readiness for change. Journal of Substance Abuse Treatment, 22, 197–209. doi: 10.1016/S07405472(02)00233-7.PubMedCrossRefGoogle Scholar
  32. Lomas, J. (1993). Diffusion, dissemination, and implementation: Who should do what? Annals of the New York Academy of Science, 703, 226–235.CrossRefGoogle Scholar
  33. Lyon, A., Charlesworth-Attie, S., Vander Stoep, A., & McCauley, E. (2011). Modular psychotherapy for youth with internalizing problems: Implementation with therapists in school-based health centers. School Psychology Review, 40, 569–581. Retrieved from
  34. Masia-Warner, C., Fisher, P., Shrout, P., Rathor, S., & Klein, R. (2007). Treating adolescents with social anxiety disorder in school: An attention control trial. Journal of Child Psychology and Psychiatry, 48, 676–686. doi: 10.1111/j.1469-7610.2007.01737.x.PubMedCrossRefGoogle Scholar
  35. Masia-Warner, C., Klein, R., Dent, H., Fisher, P., Alvir, J., Albano, A., et al. (2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of Abnormal Child Psychology, 33, i707–i722. doi: 10.1007/s10802-005-7649-z.CrossRefGoogle Scholar
  36. Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 1050–1062. doi: 10.1037/0022-006X.72.6.1050.PubMedCrossRefGoogle Scholar
  37. Mufson, L. H., Dorta, K. P., Olfson, M., Weissman, M. M., & Hoagwood, K. (2004). Effectiveness research: transporting interpersonal psychotherapy for depressed adolescents (IPT-A) from the lab to school-based health clinics. Clinical Child and Family Psychology Review, 7, 251–261. doi: 10.1007/s10567-004-6089-6.PubMedCrossRefGoogle Scholar
  38. Mychailyszyn, M. P., Mendez, J., & Kendall, P. (2010). School functioning in youth with and without anxiety disorders: Comparisons by diagnosis and comorbidity. School Psychology Review, 39, 106–121. Retrieved from
  39. New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report. Rockville, MD: US Department of Health and Human Services. Retrieved from
  40. Perepletchikova, F., Treat, T. A., & Kazdin, A. E. (2007). Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors. Journal of Consulting and Clinical Psychology, 75, 829–841. doi: 10.1037/0022-006X.75.6.829.PubMedCrossRefGoogle Scholar
  41. Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services, 38, 65–76. doi: 10.1007/s10488-010-0319-7.CrossRefGoogle Scholar
  42. Rakovshik, S. G., & McManus, F. (2010). Establishing evidence-based training in cognitive behavioral therapy: A review of current empirical findings and theoretical guidance. Clinical Psychology Review, 30, 496–516. doi: 10.1016/j.cpr.2010.03.004.PubMedCrossRefGoogle Scholar
  43. Ryan, J., & Masia-Warner, C. (2012). Treating adolescents with social anxiety disorder in schools. Child and Adolescent Psychiatric Clinics of North America, 21, 105–118. doi: 10.1016/j.chc.2011.08.011.PubMedCrossRefGoogle Scholar
  44. Schoenwald, S. K., Chapman, J. E., Kelleher, K., Hoagwood, K. E., Landsverk, J., Stevens, J., et al. (2008). A survey of the infrastructure for children’s mental health services: Implications for the implementation of empirically supported treatments (ESTs). Administration and Policy in Ment Health and Mental Health Services, 35, 84–97. doi: 10.1007/s10488-007-0147-6.CrossRefGoogle Scholar
  45. Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., et al. (2009). Mind the gap: Improving the dissemination of CBT. Behavior Research and Therapy, 47, 902–909. doi: 10.1016/j.brat.2009.07.003.CrossRefGoogle Scholar
  46. Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 37, 105–130. doi: 10.1080/15374410701817907.PubMedCrossRefGoogle Scholar
  47. Society for Research in Child Development. (2009). Healthy development: A summit on young children’s mental health. Partnering with Communication Scientists, Collaborating across Disciplines and Leveraging Impact to Promote Children’s Mental Health. Washington, DC. Retrieved from
  48. Storch, E.A., & Crisp, H.L. (2004). Taking it to the schools- transporting empirically supported treatments for childhood psychopathology to the school setting. Clinical Child and Family Psychology Review, 191–193. doi: 10.1007/s10567-004-6084-y.
  49. U.S. Department of Health and Human Services. (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda. Washington, DC. Retrieved from
  50. Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, 2753–2766. doi: 10.1056/NEJMoa0804633.PubMedCrossRefGoogle Scholar
  51. Weiner, B. J., Lewis, M. A., & Linnan, L. A. (2009). Using organization theory to understand the determinants of effective implementation of worksite health promotion programs. Health Eduation cand Research, 24, 292–305. doi: 10.1093/her/cyn019.CrossRefGoogle Scholar
  52. Weingardt, K. R., Cucciare, M. A., Bellotti, C., & Lai, W. P. (2009). A randomized trial comparing two models of web-based training in cognitive-behavioral therapy for substance abuse counselors. Journal of Substance Abuse Treatment, 37, 219–227. doi: 10.1016/j.jsat.2009.01.002.PubMedCrossRefGoogle Scholar
  53. Weist, M. D., Goldstein, J., Evans, S. W., Lever, N. A., Axelrod, J., Schreters, R., et al. (2003). Funding a full continuum of mental health promotion and intervention programs in the schools. Journal of Adolescent Health, 32, 70–78. doi: 10.1016/S1054-139X(03)00067-3.PubMedCrossRefGoogle Scholar
  54. Woodward, L. J., & Fergusson, D. M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child and Adolescen Psychiatry, 40, 1086–1093. doi: 10.1097/00004583-200109000-00018.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • Rinad S. Beidas
    • 1
  • Matthew P. Mychailyszyn
    • 2
  • Julie M. Edmunds
    • 3
  • Muniya S. Khanna
    • 1
  • Margaret Mary Downey
    • 1
  • Philip C. Kendall
    • 3
  1. 1.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Psychology/NeuropsychologyMt. Washington Pediatric HospitalBaltimoreUSA
  3. 3.Department of PsychologyTemple UniversityPhiladelphiaUSA

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