Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study
Open Access
- 13 October 2010
- journal article
- Published by Springer Science and Business Media LLC in Implementation Science
- Vol. 5 (1), 75
- https://doi.org/10.1186/1748-5908-5-75
Abstract
Although for more than a decade healthcare systems have attempted to provide evidence-based mental health treatments, the availability and use of psychotherapies remains low. A significant need exists to identify simple but effective implementation strategies to adopt complex practices within complex systems of care. Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practices. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy (CBT) in 20 Department of Veteran Affairs (VA) clinics. The 20 clinics were paired on facility characteristics, and 23 clinicians from these were trained in CBT. A clinic in each pair was randomly selected to receive external facilitation. Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not, and to better understand the relationship between individual providers' characteristics and attitudes and their CBT use. Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT. Qualitative methods were used to explore contextual and other factors thought to influence implementation. Examination of change scores showed that facilitated therapists averaged an increase of 19% [95% CI: (2, 36)] in self-reported CBT use from baseline, while control therapists averaged a 4% [95% CI: (-14, 21)] increase. Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase (35%) compared to a control therapist who was not providing CBT at baseline (10%) or to therapists in either condition who were providing CBT at baseline (average 3%). Increased CBT use was unrelated to prior CBT training. Barriers to CBT implementation were therapists' lack of control over their clinic schedule and poor communication with clinical leaders. These findings suggest that facilitation may help clinicians make complex practice changes such as implementing an evidence-based psychotherapy. Furthermore, the substantial increase in CBT usage among the facilitation group was achieved at a modest cost.This publication has 32 references indexed in Scilit:
- Multidisciplinary Cognitive-Behavioral Therapy Training for the Veterans Affairs Primary Care SettingThe Primary Care Companion For CNS Disorders, 2010
- Development of a Patient-Report Measure of Psychotherapy for DepressionAdministration and Policy in Mental Health and Mental Health Services Research, 2009
- Translating clinical training into practice in complex mental health systems: Toward opening the 'Black Box' of implementationImplementation Science, 2008
- Psychosocial and pharmacological interventions for depressed adults in primary care: A critical reviewClinical Psychology Review, 2008
- Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challengesImplementation Science, 2008
- Disseminating evidence-based practices in substance abuse treatment: A review with suggestionsJournal of Substance Abuse Treatment, 2006
- Twelve-month use of Mental Health Services in the United States - Results from the National Comorbidity Survey ReplicationArchives of General Psychiatry, 2005
- Diffusion of Innovations in Service Organizations: Systematic Review and RecommendationsThe Milbank Quarterly, 2004
- Cognitive-Behavioural Therapy in Two-Plus-One Sessions: A Pilot Field TrialBehavioural Psychotherapy, 1992
- Cognitive therapy for depression: Individual differences and the process of changeCognitive Therapy and Research, 1987