Abstract
Background
On average, psychotherapy delivered on inpatient units produces clinical outcomes with smaller effect sizes than the same treatments in outpatient settings. The Collaborative Care CBT Milieu presents opportunities to extend the benefits of the therapeutic milieu by capitalizing on paraprofessionals who have the most interactions with patients.
Methods
Mental health technicians (n = 27) were trained to use CBT strategies in daily interactions with patients on an adolescent inpatient unit. Communication about individualized CBT conceptualization and strategies were integrated into the functions of the unit across disciplines and shifts.
Results
Compared to rates of use in the year prior to training, use of physical holds was reduced by 21.25% and use of mechanical restraints was reduced by 43.98%.
Conclusions
The Collaborative Care CBT Milieu model demonstrates the feasibility of training MHTs to work in coordination with CBT therapists and other treatment team members to provide milieu interactions consistent with traditional CBT. Training staff to apply CBT theory and strategies within their scope of practice offers a pathway to an inpatient unit with a common language, shared lens for understanding patients, and unified approach to individualized care. Further research is needed to understand how these innovations impact clinical outcomes.
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Acknowledgements
Views expressed herein are those of the authors and do not reflect the official policy or position of Army Regional Health Command-Central, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force and Department of Defense or the U.S. Government.
Funding
This study was funded by a contract with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS; Creed, PI).
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Torrey A. Creed, Scott H. Waltman and Michael A. Williston declare that they have no conflict of interest.
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The Institutional Review Board of the University of Pennsylvania deemed the procedures and data collection in this study to be routine program evaluation and therefore exempt.
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Creed, T.A., Waltman, S.H. & Williston, M.A. Establishing a Collaborative Care CBT Milieu in Adolescent Inpatient Units. Cogn Ther Res 45, 428–438 (2021). https://doi.org/10.1007/s10608-020-10134-z
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DOI: https://doi.org/10.1007/s10608-020-10134-z