Breakout H – October 14, 2011 (MC: Maria Monroe-DeVita)
Presenter: Elisa V. Borah, PhD, MSW
Author: Elisa V. Borah, University of Texas Health Science Center San Antonio
Abstract: Conceptual models of EBP implementation posit relationships among practitioner attitudes, organizational features and uptake of an EBP, yet little research has explored how a constellation of provider characteristics contribute to use of evidence-based practices. This study examined the role of counselor characteristics in the use of motivational interviewing (MI) by substance abuse counselors. Results indicated that counselor characteristics indirectly affect implementation relationships such as between the amount of MI training and MI skill level, and the relationship between amount of MI training and reported use of MI. The study sample was comprised of 50 counselors from 14 Texas outpatient clinics. Multiple regression identified the relative contribution of 5 counselor characteristics (amount training, skill level, readiness, supportive attitudes, and organizational climate) on reported use of MI. Supportive attitudes and readiness each significantly contributed to counselors’ use of MI with clients. Further, supportive attitudes toward MI and readiness to use MI each partially mediated the relationship between amount of MI training and counselor use of MI. But, findings are tempered by a sample with low levels of training and low MI skill level, yet high reported usage of MI.
Presenter: R. Kathryn McHugh, PhD
Authors: R. Kathryn McHugh, Lauren C. Santucci, David H. Barlow, Boston University, and Shannon Wiltsey-Stirman, National Center for PTSD, Veterans Affairs Boston Healthcare System
Abstract: Evidence continues to accumulate supporting the efficacy, cost-efficacy, and effectiveness of computerized cognitive-behavioral therapy (cCBT) for depression and anxiety. However, little is known about the process of implementing cCBT into service provision settings. Given the many challenges inherent in the successful integration of new practices into existing systems, research on the implementation of cCBT is needed. The aim of this presentation is to discuss the implementation of cCBT in university settings. University health centers typically serve large student populations, for whom technology is easily accessed and well-integrated into daily activities; thus, these settings are particularly promising settings for the utilization of cCBT. A pilot study of the implementation and effectiveness of a cCBT program (Beating the Blues) at a large urban university found significant clinical improvement, with effect sizes comparable to controlled efficacy trials (Santucci et al., 2010). Referring clinicians and students who were enrolled in the study completed semi-structured interviews with research staff following study completion. Interviews included questions about perceptions of cCBT, treatment satisfaction, perceived effectiveness, barriers to use, and overall experience with the program. Emergent themes from these interviews will be discussed in the context of the challenges and successes associated with implementing cCBT in this population.
Debra Kaysen, Kristen P. Lindgren, University of Washington, Goran Sabir Zangana, Heartland Alliance and Iraqi Ministry of Health, Paul Bolton, Judy Bass, and Laura Murray, Johns Hopkins University, Bloomberg School of Public Health
Abstract: The Kurdish population in Iraq has high levels of exposure to criterion A events including torture, combat, genocide, and gender-based violence. Despite symptoms of PTSD, depression, and anxiety for many Kurds in Iraq, there is little published about how to approach their mental health needs. Although there is a solid empirical foundation supporting the use of Cognitive Processing Therapy for PTSD in the US, there are no randomized clinical trials testing it in a low resource setting. This paper describes the process of culturally adapting CPT for Iraqi Kurds, the process of training and supervising Kurdish paraprofessionals in implementing CPT, and preliminary results of the RCT comparing CPT to waitlist control. To date, 96 participants have completed CPT and 33 have completed the waitlist period. This is part of a larger 4-arm RCT (PI: Bolton). Challenges to using CPT in Kurdistan included low rates of literacy, high rates of poverty, stigma associated with mental health symptoms, and ongoing violence. CPT was significantly better than control for trauma symptoms, depression, traumatic grief, anxiety, and for improving overall functioning. Overall findings suggest CPT can be successfully implemented in low resource settings by trained supervised paraprofessionals. Clinical and research implications will be discussed.