Breakout D – October 13, 2011

1. Barriers to Receiving Behavioral Treatment for Obsessive Compulsive Disorder
Presentation Slides       Video of Presentation

Presenter:     Maria Mancebo, PhD
Author:     Maria Mancebo, Brown University

Abstract:     The overall aim of this qualitative study was to determine modifications to standard behavioral therapy (Exposure and Response Prevention; Ex/RP) that are needed in order to effectively deliver treatment for OCD to low-income individuals in a community mental health center.  Focus group methodology was used to assess perceptions of 9 individuals with OCD receiving treatment for OCD at a local community mental health agency.  An analysis of their responses coded from transcripts identified four key theme, which are discussed (1) Incompleteness symptoms are overrepresented and OCD symptoms are chronic, severe, and disabling; (2) Medications reduced symptoms from extreme to severe levels for some but others continue to receive treatments that they perceive to be ineffective; (3) Beliefs about OCD impact perceptions of efficacy of behavioral interventions; (4) Clients have never heard of Ex/RP or cannot access trained providers; (5) OCD symptoms result in therapy-interfering behaviors.  In addition, recommendations for modifications to standard Ex/RP are presented.


2. Barriers and solutions to Implementing Dialectical Behavior Therapy in a Community Behavioral Health System
Presentation Slides       Video of Presentation

Presenter:    Adam Carmel, MA
Authors:    Adam Carmel and Monica Rose, San Francisco Department of Public Health

Abstract:    The effectiveness of EBPI implementation efforts can be determined by examining the perspectives of stakeholders, such as clinicians administering the EBPI. Gathering qualitative data from clinicians can help to identify the specific factors that impede the successful transfer of EBPIs into clinical practice, particularly in community-based settings where challenges often arise. The current project examined the perspectives of 19 clinicians receiving DBT training as part of a performance improvement project in a public behavioral health system in San Francisco. A content analysis was conducted using data from qualitative interviews to determine the barriers to successful implementation of DBT. Solutions were generated for future models of training and implementation to address these barriers. Results indicate that effective implementation of DBT requires investment from both clinic-level and system-level administrators, and that maintenance of fidelity can be facilitated through collaboration between clinical teams at different agencies such as offering shared didactic training and merging DBT consultation teams. Additionally, clinicians reported that their non-DBT clinical responsibilities must be reduced in order to account for their involvement in DBT. Ongoing training and consultation were identified as being necessary in order to maintain fidelity to the DBT model over time.


3. Clinician Attitudes About Contingency Management in a Community Mental Health Care Setting
Presentation Slides       Video of Presentation

Presenter: Frank Angelo, BS
Authors: Frank Angelo, Debra Srebnik, Andrea Sugar, Patrick Coblentz, Michael McDonell, and Jessica Lowe, University of Washington

Background:  Contingency Management (CM) is an empirically validated behavioral treatment for substance use disorders, but is not widely available either substance abuse or mental health treatment settings. In addiction treatment settings, limited dissemination of CM has been attributed to organizational/institutional barriers and clinician objections. Less is known about barriers to implementation in community mental health centers (CMHC) settings where many individuals with co-occurring SUDs and serious mental illness receive treatment.  This study investigated addiction and mental health clinicians’ opinions of incentive-based treatments in a CMHC setting.

Methods: As part of a randomized-controlled-trial of CM, the Provider Survey of Incentives (PSI) assessing potential barriers to CM implementation was administered to 80 clinicians who provide treatment for adults with co-occurring disorders at a CMHC.  The PSI included both quantitative and qualitative items.

Results: A factor analysis of PSI scores revealed 3 main factors: positive beliefs about incentives, non-cost related barriers/objections to incentives, and barriers related to lack of funds for incentives.  Relative to other factors, clinicians perceive a lack of funding for  incentives as the most significant barriers to CM implementation.  Analysis of qualitative statements highlighted themes including: barriers to funding, detrimental effects on the therapeutic relationship, possible misuse of incentives, improved engagement of clients, and increased client motivation.

Conclusions: Positive opinions and barriers related to implementation of incentives in a CMHC setting were similar to those described previously in addiction treatment settings, with lack of funding being the most significant barrier to implementation.