The Penn Beck Community Initiative

The Penn Beck Community Initiative of the University of Pennsylvania (Penn BCI) is an award-winning clinical, educational, and research partnership with community behavioral health providers, payers, and networks, all in pursuit of the same goal: placing tangible, evidence-based tools in the hands of the front-line mental healthcare providers. The Penn BCI has implemented transdiagnostic, case conceptualization–driven cognitive behavioral therapy (CBT) in a multitude of public mental and behavioral health settings including 15+ levels of care for people across the lifespan. (See this Penn Medicine Service in Action infographic to learn more about the scope of the Penn BCI.)

The Penn BCI is characterized by three areas of emphasis that set it apart from other efforts to increase broad access to mental health evidence-based practices (EBPs). 

Implementation of CBT

While we have partnered with groups to implement a range of evidence-based practices, our primary focus is on a transdiagnostic, case-conceptualization driven CBT centered on wellness and strength. This goal-directed treatment is evidence-based 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 review of session recordings 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. Certified Peer Specialists receive specialized training to augment their skills in working with specific populations (e.g. older adults). 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 several low- and middle-income countries, adapted for the level of care and population served. These services are available in both English and Spanish, and have been refined 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 for at least 2 years after certification. 
• 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.
• 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%.