Objective Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. Method Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians’ work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. Results Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). Conclusions Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. Public Health Significance Access to EBPs in community settings has been a long-sought but slow process, and the Beck Community Initiative suggests a practical model for EBP increasing access in a large CBH network.

The present prospective study examined the relations among stressful life events, coping, and depressive symptoms in children at varied risk for depression. Participants were 227 children between 7 and 17 years old (mean age = 12.13 years, SD = 2.31, 54.6% female) who were part of a longitudinal study of depressed and nondepressed parents and their children. Youth completed measures assessing stressful life events and coping strategies at four time points over 22 months. Children’s depressive symptoms were assessed at each time point by clinical interviews of parents and children, and children’s self-report. Structural equation modeling indicated that stressful life events significantly predicted subsequent depressive symptoms. Bootstrap analyses of the indirect effects in three different models revealed that primary control engagement coping and disengagement coping strategies partially mediated the relation between stressful life events and children’s depressive symptoms across time. Regarding the direction of effects, more consistent relations were found for coping as a mediator of the link from stress to depressive symptoms than from symptoms to stress. Thus, one potential mechanism by which stressful life events may contribute to depressive symptoms in children is through less use of primary control coping and greater use of disengagement coping strategies. This is consistent with the view that the adverse effects of stress may contribute to impairments in the ability to cope effectively.

Although some treatments for depression in children and adolescents have been found to be efficacious, the effects sizes have tended to be modest. Thus, there is considerable room to improve upon existing depression treatments. Some children may respond poorly because they do not yet have the cognitive, social, or emotional maturity needed to understand and apply the skills being taught in therapy. Therefore, treatments for depression may need to be tailored to match children’s ability to both comprehend and implement the therapeutic techniques. This paper outlines the steps needed for such developmental tailoring: (1) specify the skills being taught in depression treatments; (2) identify what cognitive, social, and emotional developmental abilities are needed to attain these skills; (3) describe the normative developmental course of these skills, and how to determine a child’s developmental level; and (4) use this information to design an individualized treatment plan. Possible approaches to intervening include: alter the therapy to meet the child’s level of development, train the child on the skills needed to engage in the therapy, or apply a dynamic assessment approach that integrates evaluation into treatment and measures children’s potential as well as their current abilities.

In keeping with aspirational principles and adhering to the ethical standards of psychology, clinicians should strive to provide the highest possible quality of care and to represent their competencies accurately to potential clients. Yet how are clinicians to gauge their own competence in order to determine if they are adhering to these ethical standards and principles? Research suggests that, unfortunately, clinicians may not be the best reporters of their own abilities (Creed, Wolk, Feinberg, Evans, & Beck, 2016; Mathieson, Barnfield, & Beaumont, 2009). The current article discusses several possible explanations for this finding, including cognitive biases (e.g., better-than-average bias; J. D. Brown, 1986), therapist drift (Waller & Turner, 2016), and therapist burnout (Maslach, Schaufeli, & Leiter, 2001). Several approaches for improving clinicians’ self-awareness are discussed and practical suggestions are made. Benefits of peer consultation are highlighted, and strategies for identifying appropriate consultation group members and fostering vulnerability among members are encouraged. In addition, clinicians are urged to utilize objective tools for assessing therapeutic competence, including work sample review and outcome tracking measures. In each case, barriers to utilizing these tools and strategies to overcome these obstacles are addressed. Finally, the value of certification through an accredited body using blind, objective ratings of work products is discussed. These strategies are suggested to help improve clinician self-awareness, allowing for more accurate representation of clinical competencies, an important step toward improving access to quality health services for individuals seeking psychotherapy.

After an initial investment to build in-house CBT expertise, CMH programs were able to use a WBTP model to broaden their own capacity for high-fidelity CBT. IPEL followed by WBTP offers an effective alternative to build EBP capacity in CMH programs, rather than reliance on external experts.

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Feedback that young children receive from others can affect their emotions and emerging self-views. The current experiment tested the effect of negative content (criticism) and negative tone (hostile) of the feedback on children’s affect, self-evaluations, and attributions; we also explored whether maternal history of depression and children’s temperament moderated these relations. Participants were 152 mothers and children (48% girls) ages 4 to 5 (M= 61.6 months, SD = 6.83). The task involved three scenarios enacted by dolls; the child doll made something (e.g., picture, house, numbers) that had a mistake (e.g., no windows on the house), and proudly showed it to the mother doll, who then gave feedback (standardized, audio recorded) to the child. Children were randomized to one of four maternal feedback conditions (i.e., negative or neutral content in either a negative or neutral tone). Negative content (criticism) produced significantly more negative affect and lower self-evaluations than neutral content. When the tone of the feedback was hostile, children of mothers who had been depressed during the child’s life were significantly more likely to make internal attributions for mistakes than were children of nondepressed mothers. In addition, among children with low temperament negative affectivity, in the presence of negative tone, negative content significantly predicted more internal attributions for the errors. Findings are discussed in terms of understanding the role of evaluative feedback in children’s emerging social cognitions and affect.

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