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Level of Familiarity: All

Primary Categories: Dissemination & Implementation

Key Words: Dissemination & Implementation, race, and stigma

At the end of this session, attendees will be able to:

• Describe at least three approaches taken in a public mental health system to promote access to culturally competent, evidence-based treatment.
• Define at least two steps that can be taken to minimize disruptions in service and ensure equitable access to care during the COVID-19 pandemic
• List at least 1 system, 1 clinic, and 1 therapist-level strategy to address systemic racism and experiences of discrimination.
• Provide 1 strength and 1 challenge each when balancing fidelity and necessary adaptations to behavioral and cognitive interventions to address the needs of consumers of services offered through a public mental health system.

This panel will describe efforts to provide evidence-based treatments to individuals who seek mental health services through the City of Philadelphia's Community Behavioral Health (Medicaid reimbursement) network. Panelists will discuss steps taken to provide continuity of care and ensure access to consumers who are unable to access telehealth technologies during the COVID-19 pandemic. Additionally, panelists will share important considerations, from the system and agency levels to the therapy session itself, to address the impact of systemic racism and experiences of discrimination experienced by much of the population that seeks services within the system. Dr. Shoyinka, Chief Medical Officer of Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), will describe system-level efforts to support and promote evidence-based treatments, including training programs and policy-level interventions. Mr. Ayala, CEO, Hispanic Community Counseling Services, will discuss the agency's involvement in a CBT training program, including efforts fully implement and sustain CBT after training, and adaptations that were required to meet the needs of the population that the agency serves. Dr. Calloway, who provides CBT training through the Beck Community Initiative, will highlight considerations for training and the importance of attention to cultural competence and responsiveness when implementing CBT. Dr. Salaam will describe the perspective of a therapist who learned CBT through the city's training initiative. Mr. Inman, a mental health survivor who advocates for awareness and an end to the stigma in minority communities, will discuss essential considerations for working with mental health consumers and communities that are traditionally underserved by mental healthcare systems.

Recommended Readings:

Creed, T. A., Frankel, S. A., German, R. E., Green, K. L., Jager-Hyman, S., Taylor, K. P., ... Williston, M. A. (2016). Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative. Journal of Consulting and Clinical Psychology, 84(12), 1116.

Graham, J. R., Calloway, A., & Roemer, L. (2015). The buffering effects of emotion regulation in the relationship between experiences of racism and anxiety in a Black American sample. Cognitive Therapy and Research, 39(5), 553-563.

Naz, S., Gregory, R., & Bahu, M. (2019). Addressing issues of race, ethnicity and culture in CBT to support therapists and service managers to deliver culturally competent therapy and reduce inequalities in mental health provision for BAME service users. the Cognitive Behaviour Therapist, 12.

Williams, N. J., Wolk, C. B., Becker-Haimes, E. M., & Beidas, R. S. (2020). Testing a theory of strategic implementation leadership, implementation climate, and clinicians' use of evidence-based practice: a 5-year panel analysis. Implementation Science, 15(1), 10.

Primary Categories: Treatment- CBT, Program/Treatment Design

Key Words: Case Conceptualization/Formulation, Evidence-Based Practice, Neuroscience

Participants earn 1.5 continuing education credits

This panel discussion focuses on innovations in research and practice related to using individual patient-level data to develop personalized interventions and improve clinical outcomes. Robert DeRubeis will describe recent trends and methods in the effort to promote evidence-based predictions of individual patients' mental health intervention outcomes. He will point to promising recent uses of these methods to promote evidence-based treatment selection, more powerful between-treatment comparisons, and improvements in the allocation of mental health resources. Aaron Fisher will discuss the collection, preparation, and analysis of person-level data for generating clinical insights. In addition, he will discuss specific methods for modeling and predicting individual behavior, with an eye toward building real-time adaptive interventions. Jacqueline Persons will provide a brief review of the evidence supporting the hypothesis that therapist use of an idiographic case formulation improves outcome and reduces dropout in CBT. Dr. Siegle will review evidence from neuroimaging studies suggesting brain mechanisms associated with depression, how they change in CBT, and how their assessment can be used to predict who is likely to respond to CBT. Given multiple obstacles to using assessment of neural mechanisms to guide treatment, he will also describe an alternate approach, in which targeted pretreatments are used to address predictive mechanisms, to make it more likely that individuals who are originally predicted to not respond to CBT are more likely to respond.

At the end of this session, the learner will be able to:

• Identify how and why multivariable prediction models can be used to enhance personalized, or precision, mental health, beyond what can be achieved with research on moderators of treatment response.
• Describe idiographic science, broadly, including applications of person-specific methods to issues of personalization and prediction.
• Describe the state of the evidence supporting the hypothesis that therapist use of an idiographic case formulation improves outcome and reduces dropout in CBT.
• Identify how to improve precision in cognitive behavioral therapy by working to target individuals' brain mechanisms.

Recommended Readings:

Delgadillo, J., & Lutz, W. (2020, Advance Online Publication). A developmental pathway towards precision mental health care. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.1048

DeRubeis, R. J. (2019). The history, current status, and potential future of precision mental health. Behaviour Research and Therapy, 123, 103506. https://doi.org/10.1016/j.brat.2019.103506

Fisher, A. J., Medaglia, J. D., & Jeronimus, B. F. (2018). Lack of group-to-individual generalizability is a threat to human subjects research. Proceedings of the National Academy of Sciences. June 2018, 201711978; doi.org:10.1073/pnas.1711978115

Persons, J. B., & Hong, J. J. (2016). Case formulation and the outcome of cognitive behavior therapy. In N. Tarrier & J. Johnson (Eds.), Case formulation in cognitive behaviour therapy (2nd ed., pp. 14-37). Routledge.

Siegle, G. J., Thompson, W. K., Collier, A., Berman, S. R., Feldmiller, J., Thase, M. E., & Friedman, E. S. (2012). Toward clinically useful neuroimaging in depression treatment: Prognostic utility of subgenual cingulate activity for determining depression outcome in cognitive therapy across studies, scanners, and patient characteristics. Archives of General Psychiatry, 69(9), 913-924. NIHMSID 524641. doi:10.1001/archgenpsychiatry.2012.65