Department of Psychiatry
Penn Behavioral Health

Center for Psychotherapy Research

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Community Partnership Studies



Overview/Global IP-RISP Effort

Principal Investigator:  Paul Crits-Christoph, PhD (NIMH funded)


Purpose

This grant was a National Institutes of Mental Health (NIMH) R-24 Interventions and Practice Research Infrastructure Program (IP-RISP). The overall purpose of the program was to bridge the huge gap between academic based psychotherapy research and the practice of psychotherapy in community settings. In the past, research on various types of psychotherapy has been limited to academic settings, which do not always capture the unique challenges of serving clients in the community.

Evidence-based psychotherapies had not been widely tested in publicly funded community mental health settings with typical patients, and are not commonly delivered in such settings. The goal of the R24 award was to establish infrastructure to examine whether treatments proven efficacious in academic contexts were effective in the community when delivered by community-based providers and adapted to meet the practical constraints of service delivery in the community.

Over five years, this project sought to establish clinic-wide outcome assessment and conduct pilot studies of evidence-based treatments for depressive disorders in order to see how well these treatments adapt to the community.


Overview

The program of research was carried out in collaboration with a large non-profit, publicly funded Philadelphia community mental health agency, Northwestern Human Services of Philadelphia (NHSP). Paul Crits-Christoph, PhD, was the Principal Investigator from Penn.

Investigators from the Center for Psychotherapy Research and the administrators and providers from NHSP served as equal partners in the conceptualization of research questions, the modification of evidence-based treatments, the implementation of studies, and interpretation and dissemination of findings. Activities focused on building a successful partnership among all relevant stakeholders, including the City of Philadelphia behavioral health administration, community administrators, therapists, staff, consumers, and researchers.

Research was carried out at two NHSP facilities - the E. Mt. Airy Avenue (Northwest Philadelphia) and Knights Road (Northeast Philadelphia) locations.


Pilot studies that are a part of IP-RISP:


Engagement and Attrition Pilot Studies

Principal Investigator: Marna Barrett, Ph.D.

  • The first pilot focused on attrition during the engagement phase (i.e., no show after intake).
  • The second pilot focused on attrition from treatment itself.

The results indicate that rates of service utilization differed significantly between those seeking therapy and those seeking  medication; dropout rates and treatment intensity differed by diagnosis; consumers typically displayed one of three distinct patterns of attendance; employment was the most cited deterrent to attendance; "typical" barriers to attendance were not supported; and expectations did not predict actual treatment barriers. Unfortunately, few concrete answers were provided by the general pattern of findings with respect to addressing the problem of attrition. However, consumer expectations and attendance patterns suggest that these issues need to be discussed early on in treatment.

Information on this study was presented by Dr. Barrett at the Society for Psychotherapy Research conference in Brisbane, July 2013. See abstract for details.


Click here for additional information on Engagement and Attrition Pilot Studies



Treatment Effectiveness Pilot Studies

Supportive Expressive Therapy versus Treatment as Usual for Depression in the Community
Principal Investigator: Mary Beth Connolly Gibbons, PhD
This pilot study addresses an issue of high public health significance, namely the lack of treatment response in many patients with major depression. This pilot investigation was an effectiveness trial designed to evaluate whether supportive-expressive psychotherapy (SE) is more successful in relieving depressive symptoms than the psychotherapy normally provided by the community agency (TAU or treatment as usual). The findings of the pilot indicated that SE was more successful than TAU; moderate-to-large effect sizes were found in favor of the SE over the TAU therapy in the treatment of depression.

The article detailing the primary results can be found here: http://www.ncbi.nlm.nih.gov/pubmed/22962971

Gibbons, M. B. C., Thompson, S. M., Scott, K., Schauble, L. A., Mooney, T., Thompson, D., Green, P., MacArthur, M. J., & Crits-Christoph, P. (2012). Supportive-expressive dynamic psychotherapy in the community mental health system: A pilot effectiveness trial for the treatment of depression.Psychotherapy,49(3), 303-316.

 

Click here for additional information on Treatment Effectiveness Pilot Studies


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Influences on the Sustainability of Evidence-Based Psychotherapies

Principal Investigator: Shannon Stirman, PhD (NIMH funded)

This program of training and research facilitated the use of theory and methods of dissemination research to examine the sustainability of an implementation of cognitive therapy in community mental health agencies. A partnership formed between Philadelphia Department of Behavioral Health and the University of Pennsylvania to provide training in cognitive therapy to community mental health therapists provided the opportunity to examine a variety of factors that may be associated with the success of this effort.

The aims of the research were:

  • To assess barriers to the sustained adoption of cognitive therapy for depression and suicidal behaviors in community mental health agencies
  • To conduct preliminary research that will inform the development of an R01 to determine predictors of the sustained use of CT among newly-trained community-based therapists
  • To conduct preliminary research to determine the nature and scale of the interventions that will be necessary to promote and assess the integration and sustained use of CT in community-based settings
  • To examine ways in which CT is modified upon adoption in community mental health settings




Needs Assessment and Readiness Analysis of Community-Based Agencies in Philadelphia

Principal Investigator: Shannon Stirman, PhD (NIMH funded)

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:

  • Ability to address client needs and issues that are perceived as most central to their presenting problems
  • Reluctance to fully implement CT

Two themes were relevant to context:

  • Agency-level barriers, specifically workload and productivity concerns and reactions to change
  • 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.





Organization and Individual-level factors and the sustained use of Cognitive Therapy

Principal Investigator: Shannon Stirman, PhD (NIMH funded)

This study examined the natural trajectory of the use of cognitive therapy after training in community mental health settings over two years. The aims were to identify potential reasons for variation in training outcomes across ten agencies in a large, urban community mental health system; program evaluation data was explored and provider, consultant, and training program administrator perspectives were examined through follow-up interviews.  Several broad themes were identified from interviews:

  1. Perceptions of cognitive therapy
  2. Contextual factors
  3. Reactions to feedback on audio recordings emerged as broad categories of themes identified from interviews.

These factors may interact and impact clinician efforts to learn cognitive therapy and deliver it skillfully in their practice. The findings highlight experiences and stakeholder perspectives that may contribute to more or less successful training outcomes.

More information can be found here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3465974/

Stirman, S. W., Miller, C. J., Toder, K., Calloway, A., Beck, A. T., Evans, A. C., & Crits-Christoph, P. (2012). Perspectives on Cognitive Therapy Training within Community Mental Health Settings: Implications for Clinician Satisfaction and Skill Development.Depression Research and Treatment,2012.

http://www.ncbi.nlm.nih.gov/pubmed/22426739

Stirman, S. W., Gutiérrez-Colina, A., Toder, K., Esposito, G., Barg, F., Castro, F., Beck, A. T., & Crits-Christoph, P. (2012). Clinicians’ perspectives on cognitive therapy in community mental health settings: implications for training and implementation.Administration and Policy in Mental Health and Mental Health Services Research, 1-12.





Development of a Tool to Measure Consumer Preferences in MDD Treatment

Principal Investigator: Paul Crits-Christoph, PhD (NIMH Funded)

The overall goal of this grant is to develop and pilot an instrument that helps guide clinical treatment decisions for people seeking treatment for major depressive disorder in a community mental health setting by incorporating evidence-based practice data that has been customized to the treatment preferences of individual consumers.

The specific aims of this study are:

  • To investigate the best (i.e., valid and user-friendly) method of assessing consumer preferences for evidence-based mental health treatment.
  • To utilize consumer ratings to evaluate three preferences instruments for their clarity, difficulty, reasonableness, and comfort level.
  • To determine the ability of each measure to predict time spent in initial treatment in order to ascertain the relative validity and clinical usefulness of the instruments.



 
A Comparison of Cognitive and Dynamic Therapy for Major Depressive Disorder in Community Settings

Principal Investigator: Mary Beth Connolly Gibbons, PhD (AHRQ funded)

This five-year, federally funded study seeks to explore the effectiveness of cognitive therapy (CT) and supportive-expressive psychodynamic therapy (SE) for major depressive disorder (MDD) in community mental health centers. Although CT has been shown to be effective in the treatment of depression, very little research has been conducted examining the effectiveness of dynamic therapy, despite the frequency with which various dynamic therapies are implemented in clinical practice. This study will compare the effectiveness of the CT and SE in the treatment of depression in order to assess whether treatment with SE results in comparable alleviation of symptoms.

The specific aims of this study are to:

  • Conduct a randomized non-inferiority trial to compare SE and CT for patients with major depressive disorder, and
  • Assess the comparative effectiveness of SE and CT on secondary measures of symptoms, patient functioning, and quality of life.

 


The Development of a Therapist Feedback System for Major Depressive Disorder in Community Mental Health

Principal Investigator: Mary Beth Connolly Gibbons, PhD (NIMH funded)

This study seeks to establish a therapist feedback system to help clinicians better track their patients’ symptoms and outcome over the course of treatment. Although previous research has demonstrated that treatment outcomes improve when therapists receive feedback (regardless of whether that feedback is positive or negative), very few therapists in the community mental health system receive any feedback on the clients they treat. This study aims to increase the ease, efficiency, and frequency of delivering feedback to therapists treating patients for depression by establishing a feedback infrastructure in a community mental health setting and conducting a randomized pilot study exploring treatment outcomes when therapists receive feedback versus no feedback.

The specific aims of this study are to:

  • Develop a computerized administration of both the BASIS-24 and the Community Therapist Feedback Questionnaire (CTFQ) that is satisfactory to community consumers of mental health services,
  • Develop recovery curves for the BASIS-24 that can be used in the feedback system to identify patients who are not progressing across early treatment sessions,
  • Develop the algorithms for the CTFQ report that translate CTFQ subscale scores into clinical text,
  • Develop community-friendly reports based on both the BASIS-24 and the CTFQ that can be used to provide therapists with feedback on patients who are potential treatment failures,
  • Develop a computerized feedback system in the community mental health center to provide timely feedback reports to therapists, and
  • Conduct a pilot randomized study of therapist feedback versus no feedback in the treatment of major depressive disorder in community mental health.



 

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