SU132. Adopting Technology and a Stepped Care Approach to Advance the Implementation of Cognitive Behavioral Therapy for Psychosis (CBTp) in Community Mental Health Settings: Introducing the CBTp Project Echo Clinic

Abstract

Background: Despite national guidelines recommending CBT for psychosis (CBTp) as standard of care for individuals with psychotic disorders (Dixon et al, 2009), CBTp remains under-implemented in the United States, as fewer than 0.1% of mental health care workers in the United States are competent in the intervention (Mueser and Noordsy, 2005; Mueser, 2015). Since 2014, investigators at the University of Washington have implemented a CBTp workforce development initiative, which has led to the certification of 60 clinicians in CBTp. Methods: This presentation will describe 2 implementation model enhancements designed to improve uptake and sustainment of CBTp at community mental health agencies: (1) a stepped care approach to CBTp implementation and service delivery and (2) adaptation of a biomedical telehealth consultation platform. Results: Stepped care approaches have been appropriated for psychological therapies as a way of bridging the significant gap between the demand for evidence-based care and the available supply (Bower and Gilbody, 2005). As applied to CBTp, the stepped care model engages mental health providers with a spectrum of skills and abilities in varying levels of CBTp interventions, which are then administered based on clients’ needs and preferences. To accomplish the goal of broadening the reach of CBTp implementation while simultaneously enhancing engagement and learning strategies, a platform called Project ECHO (Extension for Community Healthcare Outcomes) was adopted to connect Washington State mental health clinicians—particularly those in rural areas—with expertise in evidence-based care for individuals with psychosis. Project ECHO is a service delivery and outcomes research collaboration aimed at building professional capacity to improve health care for underserved populations with the most challenging health problems (Arora et al, 2011). Video interface facilitates iterative guided practice and regular didactics, enabling clinicians to build proficiency in CBTp more quickly, resulting in both enhanced clinical outcomes and localized and self-sustaining expertise. Conclusion: The empirical rationale for each of these enhancements will be provided, and preliminary implementation data will be reported on 2 large, multisite community mental health agencies in Washington State.