A Statewide Common Elements Initiative for Children’s Mental Health

Abstract

Many evidence-based treatments (EBTs) for child and adolescent mental health disorders have been developed, but few are available in public mental health settings. This paper describes initial implementation outcomes for a state-funded effort in Washington State to increase EBT availability, via a common elements training and consultation approach focused on 4 major problem areas (anxiety, PTSD, depression, and behavioral problems). Clinicians (N = 180) reported significant improvement in their ability to assess and treat all problem areas at post-consultation. Clinicians from organizations with a supervisor-level “EBT champion” had higher baseline scores on a range of outcomes, but many differences disappeared at post-consultation. Outcomes suggest that a common elements initiative which includes training and consultation may positively impact clinician-level outcomes, and that having “in-house” organizational expertise may provide additional benefits.

Behavioral Rehearsal for Analogue Fidelity: Feasibility in a State-Funded Children’s Mental Health Initiative

“…In addition, study attrition at the two follow-up time points was about 20% higher when BR was included (see Lyon et al, 2014; Dorsey et al, 2014). Although we cannot definitively link enrollment and retention to BR inclusion, both variables were relatively stable across three prior evaluations (Dorsey et al, 2014).…”

“…In addition, study attrition at the two follow-up time points was about 20% higher when BR was included (see Lyon et al, 2014; Dorsey et al, 2014). Although we cannot definitively link enrollment and retention to BR inclusion, both variables were relatively stable across three prior evaluations (Dorsey et al, 2014). BR participants; however, seemed representative of trainees in that there were no significant differences between participants and non-participants across a range of characteristics (e.g., demographics, background, CBT experience).…”

“…CBT+ includes 3 days of active and experiential training (including multiple, in-training BRs with peer and trainer feedback) on the common practice elements that comprise the four CBT approaches (e.g., psychoeducation, cognitive restructuring, exposure) and core CBT techniques (e.g., agenda setting, homework assignment) (see Dorsey et al, 2014 for more information on the CBT+ approach and development). Approximately 100 clinicians are trained each year.…”

“…In Washington State, a common elements training approach informed by the work of Weisz and Chorpita (Chorpita et al, 2005; Weisz et al, 2012), the CBT+ Initiative (pronounced “CBT Plus”), has been funded by the state since 2009 (see Dorsey, Berliner, Lyon, Pullmann, & Murray, 2014). In CBT+, clinicians learn CBT for the most common clinical problems in children (i.e., behavior problems, depression, anxiety, and trauma-related anxiety).…”

“…In CBT+, clinicians learn CBT for the most common clinical problems in children (i.e., behavior problems, depression, anxiety, and trauma-related anxiety). Due to limited Initiative funding (i.e., $80,000–100,000 per year), evaluation efforts have predominantly relied on clinician self-report measures (see Dorsey et al, 2014; Lyon, Dorsey, Pullmann, Silbaugh-Cowdin, & Berliner, 2014), which may be problematic in light of findings that self-report ratings can be higher than objective ratings (e.g., Hurlburt, Garland, Nguyen, & Brookman-Frazee, 2010; Miller & Mount, 2001; Nakamura et al, 2014) (for exceptions, see Chapman, McCart, Letourneau, & Sheidow, 2013; Ward et al, 2013). Given that the ultimate goal of EBT implementation is improved outcomes for clients, EBT initiatives must demonstrate that trainees can deliver interventions with fidelity to ensure that clients served by trainees will have positive outcomes.…”