Breakout G – May 16, 2013


Video of Presentations


1.  Implementation Strategies in Social Service Settings: A Research Agenda

Presentation Slides

Presenter:  Byron J. Powell, AM

Authors:  Enola K. Proctor, PhD,1 Byron J. Powell, AM,1 & J. Curtis McMillen, PhD2

1Washington University in St. Louis; 2The University of Chicago

Abstract:  The prioritization of implementation research has yielded conceptual, empirical, and methodological advances that contribute to our understanding of the structures, processes, and outcomes of implementation.  This is perhaps an ideal time to generate a rich set of research questions pertaining to the use of implementation strategies.  This paper draws upon both the published literature and ongoing implementation research to demonstrate the challenges and opportunities associated with a number of these key questions, including:

  • How can community stakeholders inform research on implementation strategies?
  • Who are the appropriate stakeholders to be deploying implementation strategies?
  • To what extent are implementation strategies generalizable?
  • Are tailored implementation strategies more effective than other approaches?
  • Can the methods for selecting and designing implementation strategies be strengthened?
  • Can implementation strategies be adequately specified?
  • How can we disentangle the mutative factors of multifaceted implementation strategies?
  • How can (inexpensive) technologies be harnessed in developing innovative implementation strategies?
  • What is the economic impact of implementation strategies?
  • Can we develop “learning organizations??? and evidence-based systems of care?

In exploring these questions, we identify associated methodological challenges and innovative approaches to addressing them, and suggest promising directions for future studies aimed at increasing our knowledge of how to implement effective evidence-based treatments.


2. DBT Teams in Training 2008-2011: Implementation Follow-up in 2012

Presentation Slides

Presenter:  Anthony DuBose, PsyD

Authors:  Anthony DuBose, PsyD,1 André Ivanoff, PhD,1,2 Erin Miga, PhD,1,3 Linda Dimeff, PhD,4 & Marsha Linehan, PhD3

1Behavioral Tech, LLC; 2Columbia University; 3Behavioral Research & Therapy Clinics, University of Washington; 4Portland DBT Institute


Abstract:  To address the challenges of implementing evidence-based therapies in large systems, Behavioral Tech, LLC (BTECH) has begun a significant evaluation of team and system-based DBT implementations toward developing improved methods and outcomes.  As part of this, a pilot study consisted of a random sample of 50% (n=77) of teams was drawn from those completing BTECH intensive training from 2008-2011 (n=154).  Mixed methods data collection was used; an online survey including the DBT Program Elements of Treatment Questionnaire (PETQ: Schmidt, Ivanoff & Linehan, 2009) was followed by a semi-structured telephone interview to discuss team leader questions, programs goals, and next steps.  Data reveals that most programs offer individual treatment, skills training, weekly DBT consultation team, and after-hours coaching.  Approximately half of programs provide regular DBT supervision.  Thirty-nine percent of programs conduct manual-based, self-assessment of DBT adherence, although fewer (18%) provide adherence data to staff/or clients for purposes of quality improvement.   Significant implementation barriers included time constraints and staff turnover.  Team leads identified “careful selection of intensive team members??? and “sending more team members to intensive training??? as ways to improve program functioning.  In sum, while the majority of programs deliver all DBT modes, onsite DBT supervision and fidelity/adherence assessment are insufficient.


3. Understanding Modifications to CBT in Community Settings: A Comparison of Providers in Adult & Child Mental Health Service Settings

Presentation Slides

Presenter:  Shannon Wiltsey Stirman, PhD

Authors:  Shannon Wiltsey Stirman, PhD,1,2 Rinad Beidas, PhD,3 Christopher Miller, PhD,4 Julie Edmunds, MA,5 Mary Margaret Downey, BA,3 Matthew Gallagher, BA,3 Philip Kendall, PhD, ABPP,5 Katherine Toder,3 & Amber Calloway6

1National Center for PTSD; 2VA Boston Healthcare System, & Boston University; 3University of Pennsylvania; 4VA Center for Leadership, Organization, & Management Research; 5Temple University; 6University of Massachusetts at Boston

Abstract:  Little is known about modifications to CBT that providers make following training and consultation. To optimize clinician implementation and sustained use of CBT, it is necessary to investigate provider perspectives of modifications that are necessary to make CBT feasible and sustainable in a community setting. However, a challenge to understanding the nature and implications of modifications to EBPs is a lack of consistency or comprehensiveness in the classification of adaptations. This study allows us to do so with both adult and child providers in the Philadelphia community, using a framework that was developed to characterize adaptations made to evidence-based interventions. The present study examines follow-up interviews conducted 2 years following the CBT training and consultation provided in Beidas et al. (2012) and Stirman et al. (2010, 2012) with adult (n=30) and child (n=50) mental health providers. The same coding system was used for both samples to examine modifications made to CBT to facilitate comparisons between groups. The findings from this study will shed much needed insight on whether and how providers modify evidence-based treatments to make them more usable in their settings. Implications for CBT implementation and for further research will be discussed.