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The Penn Beck Community Initiative
The Penn Beck Community Initiative of the University of Pennsylvania (Penn BCI) is a public-academic partnership that began in 2007 with Penn’s Perelman School of Medicine, the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), and community mental health care providers. To date, the Penn BCI has implemented transdiagnostic case conceptualization–driven cognitive behavioral therapy (CBT) in a multitude of public mental health settings including inpatient, outpatient, intensive outpatient, residential treatment facilities, housing for chronic homelessness, school-based services, Spanish-language services, Assertive Community Treatment teams, medication-assisted treatment and other addiction services. (See Creed et al., 2014 for a full description of the Penn BCI and Creed et al., 2016 for Penn BCI implementation outcomes).
The Penn BCI is characterized by three areas of emphasis that set it apart from other partnerships that aim to increase broad access to mental health evidence-based practices (EBPs).
Emphasis on implementation process. The Penn BCI relies on a phased strategic approach with careful attention to the factors that have been found to impact the long-term outcomes of implementation efforts. A collaborative and tailored implementation-readiness phase prior to training helps organizations to take concrete actions that will increase their likelihood of long-term success.
- Emphasis on science. The Penn BCI implements CBT, which is the most widely researched and empirically supported psychotherapy across a wide spectrum of presenting problems – and that is just where our emphasis on science begins. The Penn BCI is situated at the forward edge of implementation science, including federally-funded grants to develop and study strategies to shrink the research-to-practice gap and improve access to EBPs. Penn BCI data are used to evaluate and improve the outcomes of our work, which is reflected in the evolution of our processes.
- Emphasis on sustainability. Without specific strategies to support sustainability, the best of implementation efforts may have limited long-term effects. The Penn BCI has developed the Sustained Implementation Plan to give organizations the tools they need to maintain and grow CBT over time. A webbased training (available in English and Spanish), combined with organizations’ in-house expertise, creates a conduit for adding new skilled CBT clinicians to their rosters. Recertification requirements build in a check that CBT skills are maintained over time. Advanced workshops engage clinicians in continuing to refine their skills. These and other sustainability strategies ensure that the return on investment (R01) for implementation work is high, and that all community members continue to have access to excellent care.
Finally, our focus is on a transdiagnostic CBT centered on wellness and strength. This goal-directed treatment is evidence-based, transdiagnostic, and adaptable to a wide range of treatment settings and populations. Using a personalized approach, clinicians learn to support individuals in articulating their own meaningful goals, breaking down goals into short-term steps, and reframing symptoms and impairment as challenges to be resolved in service of their recovery. In turn, individuals build hope for the future, develop skills to strive for their goals, and live the lives they choose for themselves.
Clinicians participating in the BCI receive instruction in CBT through 22 hours of intensive workshops and 6 months of weekly in-person group CBT consultation with tape review and evaluation of competence. Non-clinicians with client contact receive additional training to create a CBT-infused treatment milieu, creating a shared lens and language among services. The training model has evidenced success across a broad range of settings and populations, strengthening individual service delivery and providing clinical teams with a shared understanding of the individuals they serve. Careful attention to organizational factors, including facilitators and barriers for sustained practice build long-term CBT capacity for service programs and systems.
Selected Training and Implementation Outcomes
- The Penn BCI has implemented CBT in more than 100 behavioral health programs, 4 state systems, and Rwanda and Haiti, adapted for the level of care and population served. These services are available in both English and Spanish, and have been adapted to be culturally responsive.
- More than 2,000 clinicians (therapists, social workers, psychologists, psychiatrists) and 400 milieu staff (nurses, behavior techs, peer specialists, teachers) have been trained to apply CBT principles within their scope of work for a programmatic approach.
- Clinicians’ average CBT competency scores double and an unprecedented 84% demonstrate full CBT competence equivalent to that in clinical trials by end of training.
- Outcomes are equally strong across levels of care (traditional outpatient versus less traditional settings).
- Among those who attempt recertification, close to 90% of clinicians sustain competence over time.
- Retention is excellent (fewer than 5% drop out), and turnover among participating clinicians (13.5%) is lower than is typical in community settings (30-60%).
- After initial training, web-based training supports sustainability and increased capacity with less than 7% of the resources required for in-person training, creating a real-world model for long-term access to CBT.
- Experiential learning encourages staff to apply their new skills with themselves, targeting burnout and professional quality of life.
- Recovery is operationalized into specific strategies to engage an individual in moving toward the life he or she chooses.
- In milieu settings, CBT skills are applied in daily interactions with individuals, leading to decreased need for costly 1:1 staffing and reduction of the use of mechanical restraint by almost 50%.
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