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

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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.

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Acknowledgments

The preparation of this article was funded in part by National Institute of Mental Health grants K99-MH080100, T32MH019836, P20 MH71905and R24MH070698, and the NIMH and VA-funded Implementation Research Institute through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institutes of Health or the Department of Veterans Affairs.

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Authors and Affiliations

  1. Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 S. Huntington Ave (116B3), Boston, MA, 02130, USA

    Shannon Wiltsey Stirman & Frank Castro

  2. Department of Psychiatry, Boston University, Boston, MA, USA

    Shannon Wiltsey Stirman & Frank Castro

  3. Department of Psychology, University of Georgia, Athens, GA, USA

    Ana Gutiérrez-Colina

  4. Department of Psychiatry, University of Pennsylvania, Philadelphia, USA

    Katherine Toder, Aaron T. Beck & Paul Crits-Christoph

  5. University of Pennsylvania, Philadelphia, PA, USA

    Gregory Esposito

  6. Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania, Philadelphia, USA

    Frances Barg

  7. Department of Anthropology, University of Pennsylvania, Philadelphia, USA

    Frances Barg

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  1. Shannon Wiltsey Stirman
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  2. Ana Gutiérrez-Colina
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  3. Katherine Toder
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Correspondence to Shannon Wiltsey Stirman.

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Stirman, S.W., Gutiérrez-Colina, A., Toder, K. et al. Clinicians’ Perspectives on Cognitive Therapy in Community Mental Health Settings: Implications for Training and Implementation. Adm Policy Ment Health 40, 274–285 (2013). https://doi.org/10.1007/s10488-012-0418-8

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