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- Article (2020): Establishing a Collaborative Care CBT Milieu in Adolescent Inpatient Units. 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.
- Agency Highlight: Implementing Cognitive Therapy In Community Behavioral Health at Hispanic Community Counseling Services
- Article (2017): In-session stuck points and pitfalls of community clinicians learning CBT: A qualitative investigation. Given the preponderance of evidence supporting the efficacy of cognitive behavioral therapy (CBT), there has been an increased emphasis on dissemination to community mental health systems (CMH). Trainers from two large-scale dissemination initiatives (n = 27) were surveyed regarding the common pitfalls and difficulties encountered by CMH clinicians learning CBT. Common pitfalls were organized according to the items of the Cognitive Rating Scale (CTRS; Young & Beck, 1980) and reviewed. Guided discovery was reported to be the most challenging CBT competency to learn. Qualitative Methods were used to construct a grounded theory; trainer responses indicated they viewed the practice of CBT as not only a set of discrete skills, but also a way of thinking. Efforts may be needed to provide support, assistance, and resources to these CMH clinicians as they continue to build CBT competency.
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