Development of a Brief Group CBT Intervention to Reduce COVID-19 Related Distress Among School-Age Youth

School-aged youth have been significantly impacted by the COVID-19 pandemic. The effects of the pandemic will likely have long-standing effects on the well-being of youth, and access to mental health care is even more critical during this time. For the past 5 years, TRAILS (Transforming Research into Action to Improve the Lives of Students) has been working throughout the state to increase utilization of evidence-based mental health practices among K-12 school mental health professionals (SMHPs). By leveraging SMHPs who are widely accessible to students, TRAILS seeks to improve youth access to effective mental health care and reduce current mental health inequities. In March 2020, TRAILS responded to the COVID-19 pandemic by developing a group manual designed to be delivered virtually by SMHPs to help students develop effective coping skills to mitigate the impact of COVID-19. TRAILS focuses on promoting use of CBT and mindfulness, as these skills are ideally suited for school-based delivery, and thus the new manual, Coping with COVID-19 (CC-19), was grounded in these modalities. This article will describe the design, development, and deployment of the CC-19 program to address the mental health needs of students in the context of the pandemic. Early acceptability and penetration data will also be discussed.     

Aboriginal Practitioners Offer Culturally Safe and Responsive CBT: Response to Commentaries

We appreciate the valuable commentaries that have been provided for our paper “Can CBT be effective for Aboriginal Australians? Perspectives of Aboriginal practitioners trained in CBT.” The international authors identify how CBT, with adaptations by culturally responsive practitioners can be of value for non‐Western and Indigenous peoples. The commentary by Australian psychologists Dudgeon and Kelly questions the value of CBT for Indigenous Australians, terming it a “Western therapy” that is “culturally unresponsive” and “culturally blind.” They also critique the methodology of the study. We argue that CBT can be adapted by culturally competent practitioners to be culturally safe in Australia, as elsewhere. Cultural safety is mostly a function of the therapist, not the therapy. In the Bennett‐Levy et al. (2014) study, CBT was delivered in a culturally responsive way by Aboriginal counsellors within their own communities. CBT is a particularly adaptable and versatile therapy, and embodies principles of empowerment and self‐determination that are central to Indigenous social and emotional well‐being. We are concerned that CBT, which has strong empirical support and has been adapted elsewhere for a range of cultures, including Indigenous cultures, may be being denied to Indigenous Australian clients. There is considerable opportunity to evaluate the effectiveness and versatility of CBT, and variations of its mode of delivery, for all Australians.     

Supervision in Community Mental Health: Understanding Intensity of EBT Focus

The goal of the present study was to examine clinician, supervisor, and organizational factors that are associated with the intensity of evidence-based treatment (EBT) focus in workplace-based clinical supervision of a specific EBT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Supervisors (n = 56) and clinicians (n = 207) from mental health organizations across Washington State completed online self-report questionnaires. Multilevel modeling (MLM) analyses were used to examine the relative influence of nested clinician and supervisor factors on the intensity of EBT focus in supervision. We found that 33% of the variance in clinician report of EBT supervision intensity clustered at the supervisor level and implementation climate was the only significant factor associated with EBT supervision intensity. While individual clinician and supervisor factors may play a role in EBT coverage in supervision, our results suggest that an implementation climate that supports EBT may be the most critical factor for improving intensity of EBT coverage. Thus, implementation efforts that address the extent to which EBTs are expected, rewarded, and supported within an organization may be needed to support greater coverage of EBT during workplace-based supervision.     

Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.     

Digital Mental Health Services: Moving From Promise to Results

The papers in this special series make a compelling case for the value of digital mental health services (DMHS; including technology-based interventions, assessments, and prevention programs) to help address some of the currently unmet needs in mental health care. At the same time, the papers highlight the work that needs to be accomplished for DMHS to fulfill their promise. We review the papers’ contributions in terms of (a) the imperative to increase access to evidence-informed, high-quality care, especially for underserved populations, both in the United States and globally; (b) ways to use DMHS to improve the ways that clinical care is provided to make treatment provision more effective and efficient; and (c) the current state of the research on DMHS for emotional disorders. We then consider lessons learned and recommendations to move the field forward, such as increasing (and making transparent) the research base on DMHS, adopting regulatory standards for DMHS, attending carefully to training issues for DMHS and best practices for dissemination and implementation, designing specifically for digital platforms, and being intentional about efforts to reduce disparities regarding who benefits from DMHS.     

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

Spontaneous Self‐Practice of Cognitive Behavioural Therapy (CBT) by Aboriginal Counsellors During and Following CBT Training: A Retrospective Analysis of Facilitating Conditions and Impact

Previous cognitive behavioural therapy (CBT) training studies have suggested that therapists who practice CBT strategies on themselves during training may experience professional and personal benefits. However, it has also been reported that some CBT trainees are reluctant to engage in self‐practice. The present study reports an incidental finding from a CBT training study with Aboriginal counsellors: all five counsellors reported that they practiced CBT techniques on themselves without specific encouragement by the trainers to do so. This paper therefore posed three questions: (a) Why—in contrast to some other trainees—did this group choose to apply CBT to themselves? (b) How did they apply it—with what purpose, in what contexts, and which skills? (c) What was the impact of CBT self‐practice? Data from the group's reflections were qualitatively analysed by two of the researchers, and “member checked” by the remainder. Results indicated that the counsellors were motivated to practice CBT on themselves for two principal reasons: the value they placed on CBT, and their personal need resulting from the high number of crises experienced while living and working in their communities. The counsellors reported practicing CBT in a wide variety of contexts as part of their learning. As in previous studies, the impact of CBT self‐practice was that it increased their confidence and competence as therapists. It also appeared to be a valuable burnout prevention strategy. If the results are generalisable, they suggest that self‐experiential training in CBT may be a culturally responsive and adaptive way for Aboriginal counsellors to enhance their learning of CBT skills.     

Broadening Mental Health Services to Disadvantaged Communities in South Africa: Reflections on Establishing a Community Based Internship

The need to provide mental health services in disadvantaged communities remains a priority in South Africa. This paper illustrates how in consultation and partnership with the peri-urban community of Jamestown, a counselling psychology internship was established to provide a range of mental health services at a primary health clinic. We describe how the internship also became an important catalyst for other community interventions. We also illustrate how values of community psychology informed the establishment and foci of the internship. Tensions encountered in reconciling community needs and professional training requirements discussed include the lack of resources at the primary health care level, the bio-medical bias of the primary health setting, and addressing the needs articulated by the community for more direct interventions.     

Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis

CBT for psychosis has recently been called a best practice, suggesting that studies have demonstrated its efficacy with many populations. Community settings are encouraged to implement best practices such as CBT yet many factors can make the implementation of CBT challenging. Issues such as clinician resistance, setting, as well as client variables (refusal, denial of symptoms, etc.) come into play. Examples of successes and challenges of a community based study of CBT groups for first episodes will be described. The strategies used to overcome these challenges and the successes of the program will be presented.     

Learning from Communities: Overcoming Difficulties in Dissemination of Prevention and Promotion Efforts

The model of prevention science advocated by the Institute of Medicine (P. J. Mrazek & R. J. Haggerty, 1994) has not lead to widespread adoption of prevention and promotion programs for four reasons. The model of dissemination of programs to communities fails to consider community and organizational capacity to implement programs, ignores the need for congruence in values between programs and host sites, displays a pro-innovation bias that undervalues indigenous practices, and assumes a simplistic model of how community organizations adopt innovations. To address these faults, researchers should locate, study, and help disseminate successful indigenous programs that fit community capacity and values. In addition, they should build on theoretical models of how locally developed programs work to make existing programs and polices more effective.     

Implementation in a Changing Landscape: Provider Experiences During Rapid Scaling of Use of Evidence-Based Treatments

This study examined 133 service providers’ perspectives on a rapid shift to mandated evidence-based treatment delivery, utilizing an inductive coding process to capture themes present in their qualitative feedback. The majority of provider comments were negatively valenced, but attitudes varied considerably across response categories: comments regarding practice context and support were nearly uniformly negative, while comments regarding treatment fit and therapeutic consequences were more balanced. Treatment fit was the most commonly cited category; the fit to therapist (e.g., ease of use) subcategory was predominantly positive in contrast with the fit to client (e.g., flexibility) subcategory, which was predominantly negative. Results illustrate the intended and unintended consequences of large-scale implementation efforts on community providers, and may aid implementation researchers and system decision makers optimize the conditions under which community providers are asked to implement evidence-based treatment.     

Community Psychology and Community Mental Health: A Call for Reengagement

Community psychology is rooted in community mental health research and practice and has made important contributions to this field. Yet, in the decades since its inception, community psychology has reduced its focus on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses. This special issue endeavors to highlight current efforts in community mental health from our field and related disciplines and point to future directions for reengagement in this area. The issue includes 12 articles authored by diverse stakeholder groups. Following a review of the state of community mental health scholarship in the field's two primary journals since 1973, the remaining articles center on four thematic areas: (a) the community experience of individuals with serious mental illness; (b) the utility of a participatory and cross‐cultural lens in our engagement with community mental health; (c) Housing First implementation, evaluation, and dissemination; and (d) emerging or under‐examined topics. In reflection, we conclude with a series of challenges for community psychologists involved in future, transformative, movements in community mental health.     

Enhancing Cognitive‐Behavioural Therapy (CBT) Skill Acquisition Through Experiential and Reflective Learning: A Commentary on Studies Examining the Impact of Self‐Practice and Self‐Reflection in CBT

Self‐practice and self‐reflection (SP/SR) is a targeted training tool that is intended to increase CBT competency in therapists. The four articles reviewed in this commentary examine the benefits of SP/SR with various types of therapists, and survey the significant obstacles faced in implementing this tool with clinicians. Collectively, these articles conclude that SP/SR is a valuable tool in improving CBT skill acquisition and preventing burnout, particularly with difficult patients, but that most therapists elect not to use it largely because of the time involved in engaging in it. In this commentary, I suggest that empirical studies with larger samples and controlled designs are needed to build on the wealth of qualitative data collected to date in order to assess the value added by SP/SR compared with other training methods, and in order to determine its impact on a range of therapeutic outcomes. I also suggest that future studies should examine the efficacy of required SP/SR engagement, isolate its critical ingredients, and assess if there are clients and therapists for whom SP/SR is comparably more effective.     

Sustainability of Teacher Implementation of School-Based Mental Health Programs

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.     

Community perceptions of mental disorders: a Greek perspective

The present cross‐sectional study examines the perceptions of residents of a rural community in Greece pertaining to the interpretation, explanation, treatment and prognosis of various psychological problems. In all, 100 community residents took part. A series of vignettes in combination with both qualitative and quantitative data collection procedures was employed. The findings indicate a variation in the endorsement of interpretations and causal attributions as a function of the type of symptomatology presented. The overt psychotic cases of schizophrenia were more likely to be understood within a genetic explanatory framework while the less overt symptoms of mental disorders were perceived as being indicative of emotional problems triggered by personality and social environmental factors. A preference for psychological methods of treatment was expressed. Copyright © 2006 John Wiley & Sons, Ltd.     

Shared Communities: A Multinational Qualitative Study of Immigrant and Receiving Community Members

Community psychology is central to understanding how immigrants and more established residents of their new settings join together to develop a shared sense of community and membership. In our present study, we explored how newer (i.e., first‐ and second‐generation immigrants) and more established community members form multiple positive psychological sense of community (PSOC) with one another. We conducted a multinational, qualitative study of PSOC through interviews with 201 first‐ and second‐generation immigrants and third generation or more “receiving community members” in three contexts (Baltimore‐Washington corridor of the U.S.; Torino, Italy; Lecce, Italy). Results indicated numerous similarities among the ways in which participants constructed PSOC in shared and nonshared communities, regardless of immigration/citizenship status, length of community residence, city, country, age, or gender. Small, proximal, and salient communities were often particularly important to building positive PSOC, which was formed around diverse membership boundaries. As intersectional beings, members converged and diverged on many characteristics, providing multiple opportunities for members to bring diversity to their communities while sharing other characteristics deemed essential to membership. Nonetheless, findings point to significant, structural challenges rooted in power and privilege that must be confronted to bridge the community‐diversity dialectic and build strong, shared sense of community.     

Reaching Out: Improving the Continuity of Care of Community Mental Health Services Through a Weekly Climbing Group

This mixed-method study examined the impact of a novel activity group on engagement in care. Thirty-two participants were recruited from National Health Service (NHS) community mental health services in three inner-London boroughs. Participants undertook eight weekly sessions of supervised climbing. There was a significant quantitative improvement in the domain “individual progress” (Z = 2.12, p = 0.03). Qualitative data indicated a wide range of benefits. The study identified both direct and indirect benefits to continuity of care. The study validates the use of a climbing activity group to engage and benefit community mental health service users.     

Twenty Years Post‐genocide: The Creation of Mental Health Competence among Rwandan Survivors Through Community‐based Healing Workshops

Twenty years after the genocide, many Rwandans still suffer from the psychological wounds of the past. The country's mental health agenda is based on individualised and psychiatric approaches that help some but cannot be provided on a large scale. Further, many reconciliation initiatives have been based on public testimonies, which have been shown to be potentially re‐traumatising, leading to calls for small‐scale community‐based approaches to healing, which constitute a middle way between individualised and public approaches. Drawing on the concept of ‘mental health competence’ (Campbell and Burgess, 2012), this study evaluates one such approach: the Life Wounds Healing workshops offered by the African Institute for Integral Psychology. Twenty‐one semi‐structured interviews were conducted with former workshop participants, staff members and the institute's founder to investigate their views on how these workshops can help genocide survivors. The results suggest that the workshops succeed in creating mental health competence by establishing a safe social space for people to open up, increasing people's critical understandings of the processes of pain — and potential for healing — that informs behaviour change, generating bonding social capital and offering participants' income‐generating possibilities. Copyright © 2015 John Wiley & Sons, Ltd.     

Integrating Behavioral Aspects into Community Preparedness and Response Systems

Summary

This article examines the role of psychosocial and behavioral dimensions of terrorism that influence community preparedness and homeland defense efforts. Public health interventions will fail if people do not follow the recommendations. A broader public health model is applied to help identify the interactions between risk and safety appraisals, social factors, and behavioral response to uncertain and stressful situations. Community preparedness would benefit by linking disparate programmatic and advocacy initiatives that already exist. It stands to reason that improving the cohesiveness of existing systems of social organization would strengthen community resilience and serve as effective countermeasures for terrorism.