Community Mental Health Provider Modifications to Cognitive Therapy: Implications for Sustainability
Open accessAbstract
OBJECTIVE: This study identified modifications to an evidence-based psychosocial treatment (cognitive therapy) within a community mental health system after clinicians had received intensive training and consultation. METHODS: A coding system, consisting of four types of contextual modifications, 12 types of content-related modifications, seven levels at which modifications can occur, and a code for changes to training or evaluation processes, was applied to data from interviews with 27 clinicians who treat adult consumers within a mental health system. RESULTS: Nine of 12 content modifications were endorsed, and four (tailoring, integration into other therapeutic approaches, loosening structure, and drift) accounted for 65% of all modifications identified. Contextual modifications were rarely endorsed by clinicians in this sample. Modifications typically occurred at the client or clinician level. CONCLUSIONS: Clinicians in community mental health settings made several modifications to an evidence-based practice (EBP), often in an effort to improve the fit of the intervention to the client's needs or to the clinician's therapeutic style. These findings have implications for implementation and sustainability of EBPs in community settings, client-level outcomes, and training and consultation.
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Providers of psychosocial interventions frequently modify interventions for a variety of reasons, including perceived client preferences, providers' preferences or self-efficacy, and efforts to maintain a good therapeutic alliance.
“Providers of psychosocial interventions frequently modify interventions for a variety of reasons, including perceived client preferences, providers’ preferences or self-efficacy [54], and efforts to maintain a good therapeutic alliance [55–58].”
From The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions (2019) · cites this paper as [56]
Providers may over-report some forms of modification, while underreporting others.
“Providers may over-report some forms of modification (c.f., [56]), while underreporting others.”
From The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions (2019) · cites this paper as [56]
The citation is attached to the suggestion that providers may over-report modifications. The Discussion (page unavailable) says clinician descriptions were not checked against session observations and that clinicians and observers might differ, but it does not say providers may over-report any form of modification. I searched for over-reporting and self-report bias in our copy. (LLM, conf=0.72)
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Cites
Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012) · Implementation Science · doi:10.1186/1748-5908-7-17 · Cited by 1,355 · see citing works
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Wiltsey Stirman, S., Baumann, A. A., & Miller, C. J. (2019) · Implementation Science · doi:10.1186/s13012-019-0898-y · Cited by 1,329 · see citing works
Self-citationStirman, S. W., Miller, C. J., Toder, K., & Calloway, A. (2013) · Implementation Science · doi:10.1186/1748-5908-8-65 · Cited by 691 · see citing works
Self-citationWiltsey Stirman, S., A Gutner, C., Crits-Christoph, P., Edmunds, J., Evans, A. C., & Beidas, R. S. (2015) · Implementation Science · doi:10.1186/s13012-015-0308-z · Cited by 188 · see citing works
Self-citationMiller, C. J., Wiltsey‐Stirman, S., & Baumann, A. A. (2020) · Journal of Community Psychology · doi:10.1002/jcop.22279 · Cited by 138 · see citing works
Self-citationWiltsey Stirman, S., Gamarra, J. M., Bartlett, B. A., Calloway, A., & Gutner, C. A. (2017) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12218 · Cited by 138 · see citing works
Self-citationAssessing Implementation Strategy Reporting in the Mental Health Literature: A Narrative Review
Hooley, C., Amano, T., Markovitz, L., Yaeger, L., & Proctor, E. (2020) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-019-00965-8 · Cited by 42 · see citing works
Mignogna, J., Martin, L. A., Harik, J., Hundt, N. E., Kauth, M., Naik, A. D., Sorocco, K., Benzer, J., & Cully, J. (2018) · Implementation Science · doi:10.1186/s13012-018-0768-z · Cited by 47 · see citing works
Martin, P., Murray, L. K., Darnell, D., & Dorsey, S. (2018) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12270 · Cited by 53 · see citing works
Wiltsey Stirman, S., Finley, E. P., Shields, N., Cook, J., Haine-Schlagel, R., Burgess, J. F., Dimeff, L., Koerner, K., Suvak, M., Gutner, C. A., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0544-5 · Cited by 35 · see citing works
Self-citation
- Authors
- Wiltsey Stirman, S., Calloway, A., Toder, K., Miller, C. J., DeVito, A. K., Meisel, S. N., Xhezo, R., Evans, A. C., Beck, A. T., & Crits-Christoph, P.
- Affiliations
- Dr. Wiltsey Stirman is affiliated with the Women’s Health Sciences Division, Veterans Affairs (VA) National Center for PTSD at the VA Boston Healthcare System, and with the Department of Psychiatry, Boston University, 150 S. Huntington Ave. (116B3), Boston, MA 02130 (e-mail: ). Ms. Calloway is with the Department of Psychology, University of Massachusetts, Boston. Ms. Toder, Dr. Beck, and Dr. Crits-Christoph are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Miller is...
- Boston University (US)
- ORCID
- Venue
- Psychiatric Services
- Published
- 2013-10
- Volume
- 64
- Issue
- 10
- Pages
- 1056-1059
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- PMC
- PMC3851297
- OpenAlex
- W2000632076
- Cited by
- 63
- References
- 3
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 10 · 2018: 6 · 2017: 4 · 2016: 5 · 2015: 3 · 2014: 1 · 2013: 1
- FWCI
- 6.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs (R25 MH080916-01A2)
- Health Services Research and Development
- Washington University in St. Louis (R25 MH080916-01A2)
- Quality Enhancement Research Initiative (R25 MH080916-01A2)
- National Institute of Mental Health (MH080916, R00 MH 01800, R00MH080100, K08MH001800, R25MH080916)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- cognitive therapy, evidence-based practice, treatment modification, community mental health services, implementation sustainability
- MeSH terms
- Adult, Mental Disorders, Community Mental Health Services, Female, Humans, Male, Program Evaluation, Cognitive Behavioral Therapy
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