Community Mental Health Training Research Articles

From court to the community: improving access to evidence-based treatment for underserved youth involved in the juvenile legal system at-risk for suicide

BackgroundJuvenile legal involved youth (JLIY) experience disproportionately high rates of suicidal and self-injurious thoughts and behaviors (SSITB). Many JLIY lack access to evidence-based treatment specifically designed to treat SSITB, thereby increasing the overall risk of suicide. The overwhelming majority of JLIY are not placed in secure facilities and almost all incarcerated youth are eventually released to the community. Consequently, SSITB are a major concern of JLIY residing in the community and it is critical that this population has access to evidence-based treatment for SSITB. Unfortunately, most community mental health providers who treat JLIY have not been trained in evidence-based interventions that are specifically designed to SSITB, which often leads to youth experiencing prolonged periods of SSITB. Training community mental health providers who serve JLIY in the detection and treatment of SSITB shows promise for decreasing the overall suicide risk for JLIY.MethodsThe current proposal aims to reduce SSITB among JLIY, and thus reduce mental health disparities in this vulnerable and underserved youth population, by increasing access to evidence-based treatment strategies specifically designed to treat SSITB behaviors. We will implement an agency-wide training among at least 9 distinct community mental health agencies that serve JLIY referred to treatment by a statewide court system in the Northeast. Agencies will be trained in an adapted version of the COping, Problem Solving, Enhancing life, Safety, and Parenting (COPES+) intervention. Training will be implemented via a cluster-randomized stepped wedge trial that proceeds through multiple phases.DiscussionThis research engages multiple systems (i.e., juvenile legal and mental health systems) serving JLIY and has the potential to directly inform treatment practices in juvenile legal and mental health systems. The current protocol has significant public health implications as the primary goals are to reduce SSITB among adolescents involved in the juvenile legal system. By implementing a training protocol with community-based providers to help them learn an evidence-based intervention, this proposal aims to reduce mental health disparities in a marginalized and underserved population.Trial registrationosf.io/sq9zt

The effectiveness of training community mental health therapists in an evidence-based intervention for ASD: Findings from a hybrid effectiveness-implementation trial in outpatient and school-based mental health services.

Publicly funded mental health services play an important role in caring for school-age children with autism spectrum disorder (ASD); however, therapists report a lack of specialized ASD training, which families identity as a barrier in obtaining mental health services for their children. An Individualized Mental Health Intervention for ASD (AIM HI) was developed in collaboration with community stakeholders to respond to identified needs of children and community therapists. The current study examined the effects of therapist training in AIM HI on the changes in therapist practice, including therapists' use of evidence-based intervention strategies in session. Data were collected from a study conducted in community outpatient and school based mental health programs randomly assigned to receive AIM HI therapist training or observation of routine care. Therapist and child clients were enrolled from participating programs. Therapists in AIM HI training received training and consultation for 6 months while delivering the AIM HI intervention to a participating client; therapists in usual care delivered routine care. Both groups of therapists video recorded psychotherapy sessions which were scored by trained raters. Differences between training groups were examined using multilevel modeling. Therapists trained in AIM HI were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more effective pursuit of caregiver and children skill teaching. Therapist licensure moderated some training outcomes.

Moving to know boundaries: applying dance movement therapy in body privacy training

ABSTRACT Dance movement therapy as a specific form of psychotherapy has its successful applicability in various psycho-social intervention programmes. However, the most common utilisation of this therapy has been observed in the clinical and rehabilitation fields. Its applicability in community mental health training, though not totally overlooked, but not empirically explored as well. The present work tried to bridge this research gap in relation to training and development in children. This study has focused on understanding dance movement therapy’s role in training children with the concept of body privacy, at the same time developing healthy body image, and facilitating communication skills in them. Qualitative techniques were employed for data collection and analysis purpose. The findings were intriguing in terms of evaluating dance movement therapy as a training process to teach children body privacy concept, which can further find its application in school counselling and various other child training and intervention programmes.

Feasibility and Preliminary Effectiveness of a Peer-Developed and Virtually Delivered Community Mental Health Training Program (Emotional CPR): Pre-Post Study

BackgroundThe COVID-19 pandemic has led to a global mental health crisis, highlighting the need for a focus on community-wide mental health. Emotional CPR (eCPR) is a program and practice developed by persons with a lived experience of recovery from trauma or mental health challenges to train community members from diverse backgrounds to support others through mental health crises. eCPR trainers have found that eCPR may promote feelings of belonging by increasing supportive behaviors toward individuals with mental health problems. Thus, clinical outcomes related to positive and negative affect would improve along with feelings of loneliness.ObjectiveThis study examined the feasibility and preliminary effectiveness of eCPR.MethodsWe employed a pre-post design with 151 individuals, including peer support specialists, service users, clinicians, family members, and nonprofit leaders, who participated in virtual eCPR trainings between April 20, 2020, and July 31, 2020. Instruments were administered before and after training and included the Herth Hope Scale; Empowerment Scale; Flourishing Scale (perceived capacity to support individuals); Mindful Attention Awareness Scale; Active-Empathic Listening Scale (supportive behaviors toward individuals with mental health challenges); Social Connectedness Scale (feelings of belonging and connection with others); Positive and Negative Affect Schedule; and University of California, Los Angeles 3-item Loneliness Scale (symptoms and emotions). The eCPR fidelity scale was used to determine the feasibility of delivering eCPR with fidelity. We conducted 2-tailed paired t tests to examine posttraining improvements related to each scale. Additionally, data were stratified to identify pre-post differences by role.ResultsFindings indicate that it is feasible for people with a lived experience of a mental health condition to develop a program and train people to deliver eCPR with fidelity. Statistically significant pre-post changes were found related to one’s ability to identify emotions, support others in distress, communicate nonverbally, share emotions, and take care of oneself, as well as to one’s feelings of social connectedness, self-perceived flourishing, and positive affect (P≤.05). Findings indicated promising evidence of pre-post improvements (not statistically significant) related to loneliness, empowerment, active-empathetic listening, mindfulness awareness, and hope. Nonprofit leaders and workers demonstrated the greatest improvements related to loneliness, social connectedness, empathic listening, and flourishing. Peer support specialists demonstrated the greatest improvements related to positive affect, and clinicians demonstrated the greatest improvements related to mindfulness awareness.ConclusionsPromising evidence indicates that eCPR, a peer-developed and peer-delivered program, may increase feelings of belonging while increasing supportive behaviors toward individuals with mental health problems and improving clinical outcomes related to positive and negative affect and feelings of loneliness.

Exploring virtue ethics in psychodynamic psychotherapy: latent changes in humility, affect regulation, symptoms and well‐being

AbstractA rising interest in virtues in psychotherapy has spurred empirical exploration of their influence on both mental health symptoms and well‐being. As such, we explored the virtue ethics premise that growth in the virtue of humility may ameliorate mental health symptoms and promote well‐being. We also examined whether change in experiential avoidance was a mechanism of these changes. Using a multiple simultaneous latent change score model, we analysed latent changes among humility, experiential avoidance and the outcomes of symptoms and social well‐being in a sample of clients (N = 778; M = 31.56 years of age; 59.4% female; 78.1% White) who received outpatient contemporary relational psychotherapy at a community mental health training clinic. Results indicated that change in humility corresponded to changes in symptoms and social well‐being through change in experiential avoidance. Clinical implications centre on clinicians attending closely to client experiences of oscillation between self‐abasement and self‐superiority and utilising small ways within the therapeutic encounter to foster humility.

Evaluating a Train-the-Trainer Approach for Increasing EBP Training Capacity in Community Mental Health.

Research suggests the train-the-trainer (TtT) model may be an effective approach to training community mental health providers in evidence-based practice (EBP). This study compared pre- and post-training consultation outcomes as well as standardized measures of trainer attributes and behaviors between university-based master trainers and experienced community-based supervisors, trained under the TtT approach. Findings suggest local and master trainers are equivalent in terms of clinical teaching effectiveness and trainee-perceived charisma. Master trainers may have higher trainee-perceived credibility, but training and consultation outcomes are equivalent across the types of trainers, with the exception of behavioral problems where clinicians trained by local trainers and master trainers saw significantly greater growth than those who received training and consultation by master trainers.

Latent trajectories of change for clients at a psychodynamic training clinic.

Employing practice-based research methods, we addressed the need to examine the effectiveness of psychodynamic treatment as a supplement to the efficacy evidence offered by randomized clinical trials. We used person-centered analyses to generate latent subgroups of clients (N = 118; M age = 40.92; 53.4% female; 81.4% Caucasian; 80.5% heterosexual) receiving contemporary relational psychotherapy (CRP) at a psychodynamic community mental health training clinic. Subgroups of clients reported a change in depression, social conflict, and anxiety symptomatology, and overall life satisfaction, depicted by significant quadratic growth curves. Findings also offered exploratory support for a theoretical proposition from CRP that improved relational functioning would correspond to improved affect dysregulation and overall life satisfaction. Clinical and training implications highlight the need to distinguish subgroups of "responders" and "nonresponders" to inform treatment.

Understanding the needs of LGBTQ clients and their risk for commercial sexual exploitation: Training community mental health workers

Training on commercial sexual exploitation (CSE) and victimization of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youths can increase awareness among professionals who provide services to this community. This study evaluated the effectiveness of a community-based training program geared toward mental health workers in a diverse metropolitan city. The training provided information about the continuum of sexuality and gender identity, sensitivity when working with LGBTQ clients, LGBTQ clients’ risks for CSE, and ways to improve service delivery to this population. Participants’ (N = 64) knowledge level of these areas was examined prior to the training, immediately thereafter, and in a six-month follow-up. Participants showed an increase in knowledge from pretest to posttest. Follow-up testing on a limited sample revealed scores that were lower than posttest scores, but higher than pretest scores. Overall, through this community-based training, participants gained knowledge about the continuum of sexual and gender identity, appropriate service delivery when working with LGBTQ individuals, and the risk factors for CSE for LGBTQ youths. Participants also reported feeling satisfied with the training approach and format. Implications for future training to enhance mental health workers’ competence with LGBTQ victims of sexual exploitation are explored.

The effect of a community mental health training program for multidisciplinary staff

BackgroundPrimary health workers play a critical role in providing health education to people with mental disorders. In China community health workers working with people with mental health problems lack experience and training in this area. Additionally, coordination between hospital and community staff is not well established. The aim of this study was to provide an interdisciplinary community mental health training program and to evaluate the effect of the training on staff knowledge about mental health and confidence in their roles. MethodsA three-day community mental health training program was offered specifically for interdisciplinary mental health professionals. Using a one-group pre-test post-test design, participants completed a self-assessment of mental health concepts and program evaluation which included asking participants to rate their satisfaction using a five-point Likert scale and to respond to open-ended questions. ResultsForty-eight participants including health professionals from colleges, hospital and community health centers were recruited. Only 8.7% of participants had ever received community mental health training. Post-test evaluation demonstrated improvements in knowledge, and most participants were very satisfied with the program. ConclusionThe findings indicate that this brief interdisciplinary training program had a positive effect in improving knowledge about community mental health concepts and confidence in dealing with people with mental health disorders for multidisciplinary staff working in primary health care areas.

Testing a Web-Based, Trained-Peer Model to Build Capacity for Evidence-Based Practices in Community Mental Health Systems.

Use of expert-led workshops plus consultation has been established as an effective strategy for training community mental health (CMH) clinicians in evidence-based practices (EBPs). Because of high rates of staff turnover, this strategy inadequately addresses the need to maintain capacity to deliver EBPs. This study examined knowledge, competency, and retention outcomes of a two-phase model developed to build capacity for an EBP in CMH programs. In the first phase, an initial training cohort in each CMH program participated in in-person workshops followed by expert-led consultation (in-person, expert-led [IPEL] phase) (N=214 clinicians). After this cohort completed training, new staff members participated in Web-based training (in place of in-person workshops), followed by peer-led consultation with the initial cohort (Web-based, trained-peer [WBTP] phase) (N=148). Tests of noninferiority assessed whether WBTP was not inferior to IPEL at increasing clinician cognitive-behavioral therapy (CBT) competency, as measured by the Cognitive Therapy Rating Scale. WBTP was not inferior to IPEL at developing clinician competency. Hierarchical linear models showed no significant differences in CBT knowledge acquisition between the two phases. Survival analyses indicated that WBTP trainees were less likely than IPEL trainees to complete training. In terms of time required from experts, WBTP required 8% of the resources of IPEL. After an initial investment to build in-house CBT expertise, CMH programs were able to use a WBTP model to broaden their own capacity for high-fidelity CBT. IPEL followed by WBTP offers an effective alternative to build EBP capacity in CMH programs, rather than reliance on external experts.

Universities and third sector working in partnership to co-deliver accredited, community mental health training

Universities and third sector working in partnership to co-deliver accredited, community mental health training

Training community mental health staff in Guangzhou, China: evaluation of the effect of a new training model.

BackgroundIncreasing numbers of people with mental disorders receive services at primary care in China. The aims of this study are to evaluate impact of a new training course and supervision for community mental health staff to enhance their levels of mental health knowledge and to reduce their stigmatization toward people with mental illness.MethodsA total of 77 community mental health staff from eight regions in Guangzhou in China were recruited for the study.4 regions were randomly allocated to the new training model group, and 4 to the old training model group. Levels of mental health knowledge were measured by purpose-made assessment schedule and by the Mental Health Knowledge Schedule (MAKS). Stigma was evaluated by the Mental Illness: Clinicians’ Attitudes Scale (MICA) and the Reported and Intended Behavior Scale (RIBS). Evaluation questionnaires were given at the beginning of course, at the end, and at 6 month and at 12 month follow-up.ResultsAfter the training period, the 6-month, and the 12-month, knowledge scores of the intervention group were higher than the control group. At 6-month and 12-month follow-up, means scores of MAKS of the intervention group increased more than the control group (both p < 0.05) when age, sex, marriage status, title and time were controlled for. At 6-month follow-up, means scores of MICA of the intervention group decreased more than that of the control group (p < 0.01). At after-training, at 6-months, and at 12-months, mean scores of RIBS of the intervention group increased more than the control (p < 0.01, p < 0.001, p < 0.001) when age, sex, marriage status, title and time were controlled for.ConclusionsCompared with the traditional training course and supervision, the new course improved community mental health staff knowledge of mental disorders, improving their attitudes toward people with mental disorder, and increasing their willingness to have contact with people with mental disorder.

Accelerating Science-to-Practice for Early Psychosis.

It takes approximately 17 years for research findings to influence clinical practice, and even longer for a scientific discovery to have an impact on public health. Seventeen years also falls within the lower bound of the age of onset for schizophrenia, a devastating mental disorder characterized by recurrent psychotic episodes and accumulating disability. To improve outcomes for young adults with early psychosis, NIMH launched the Recovery After an Initial Schizophrenia Episode (RAISE) initiative in 2008. The goals were to develop a comprehensive, person-centered intervention for first-episode psychosis (FEP), test it in U.S. community treatment settings, and expedite dissemination, adoption, and implementation of promising findings. Rapid uptake of evidence-based interventions can occur when clinical research purposefully bridges gaps between service users’ needs, scientific curiosity, and policy makers’ concerns. The RAISE funding announcement took this into account and required investigators to establish partnerships with principal stakeholders—that is, service users, family members, clinicians, and health care administrators—at every stage of the research process. RAISE investigators studied implementation processes alongside outcomes and developed training and program materials to support the establishment of coordinated specialty care (CSC) programs in community clinics. The articles and columns in the special section suggest notable progress after only seven years— a decade earlier than the often cited 17 years—because they address implementation challenges and answer questions about feasibility, accountability, acceptability, effectiveness, and sustainability. Is it feasible to implement CSC programs in routine settings? Yes. The articles by Dixon and colleagues and byMueser and colleagues each describe team-based multicomponent programs for FEP. Across the two RAISE studies, 19 new CSC programs were established by training community mental health providers in stage-specific care for FEP. Can treatment fidelity be monitored in a practical way? Yes. The Best Practices column by Essock and colleagues describes an approach to CSC fidelity monitoring that uses information drawn from readily available data, such as routine service logs. Practical approaches to fidelity monitoring may be cost-effective and can provide an ongoing data source for quality improvement activities. Will young adults with FEP engage in treatment? Yes. Less than 10% of RAISE Connection participants dropped out over two years. Lucksted and colleagues highlight several features that promoted engagement: the individualized, flexible, and recovery-focused nature of treatment; the emphasis on shared decision making; and the availability of services such as supported employment and education. Are CSC programs effective? Yes. After one year of treatment, Srihari and colleagues found fewer hospitalizations and higher vocational engagement among CSC patients compared with those in usual care. Likewise, over two years, Dixon and colleagues noted significant improvements in symptoms, social functioning, and school and work activity among Connection Program participants. Are CSC programs sustainable? Perhaps. In the Research & Services Partnerships column, Essock and colleagues describe how state mental health authorities in New York and Maryland supported implementation, evaluation, and expansion of the Connection Program. Involvement in RAISE influenced each state’s decision to commit funds to extend early intervention services. The novel three-part financing model proposed by Frank and colleagues in the Economic Grand Rounds column offers another strategy for achieving sustainability: a payment system that rewards delivery of high-quality FEP care. These articles and columns convey hope that integrated and effective care for FEP is possible in the United States. As CSC programs multiply, we must anticipate new challenges that might reduce the public health impact of early intervention programs. Addington and colleagues’ brief report reminds us that many persons with FEP endure long periods of untreated psychosis, which augurs poorly for long-term recovery. Ouellet-Plamondon and colleagues in Canada alert us to potential disparities in access among minority groups and the need for different engagement strategies. Close partnerships between investigators and stakeholders will be critical for further progress. Through dynamic partnerships and ongoing collaboration, we should strive to make 17 years the age at which psychosis is prevented.

Forty Days after the Great East Japan Earthquake: Field Research Investigating Community Engagement and Traumatic Stress Screening in a Post-Disaster Community Mental Health Training

The current article describes the results of posttraumatic stress educational outreach and screening offered to 141 citizens of Japan who attended a public-service mental health training regarding post-disaster coping 40 days after a 6.8 Richter Scale earthquake, local and regional deaths, and an ongoing nuclear radiation threat. Attendees were given access to anonymous questionnaires that were integrated into the training as a tool to help enhance mental health literacy and bridge communication gaps. Questionnaires were turned in by a third of those in attendance. Among respondents, multiple exposures to potentially-traumatic events were common. More than a quarter of respondents met criteria for probable PTSD. Physical health and loss of sense of community were related to PTSD symptoms. Associations and diagnosis rates represented in these data are not generalizable to the population as a whole or intended for epidemiological purposes; rather, they are evidence of a potentially useful approach to post-disaster clinical screening, education, and engagement. Results are presented in the context of previous findings in Japan and ecologically-supportive post-disaster field research is discussed.

Training Community Mental Health Therapists to Deliver a Package of Evidence-Based Practice Strategies for School-Age Children with Autism Spectrum Disorders: A Pilot Study

Research on moving evidence-based practice (EBP) intervention strategies to community service settings for children with autism spectrum disorders (ASD) is urgently needed. The current pilot study addresses this need by examining the feasibility, acceptability and preliminary outcomes of training therapists practicing in community mental health (CMH) clinics to deliver a package of EBP strategies aimed to reduce challenging behaviors in school-age children with ASD. Results indicate that CMH therapists participated in both initial and ongoing training, were able to deliver the intervention with fidelity, and perceived the intervention strategies as useful. Parents participated in almost all sessions with their children and remained in therapy when therapists delivered the intervention. Meaningful reductions in child problem behaviors occurred over 5 months providing promising support for the intervention.

Can Dialectical Behavior Therapy Be Learned in Highly Structured Learning Environments? Results From a Randomized Controlled Dissemination Trial

This study evaluated the efficacy of methods of training community mental health providers ( N = 132) in dialectical behavior therapy (DBT) distress tolerance skills, including (a) Linehan's (1993a) Skills Training Manual for Borderline Personality Disorder (Manual), (b) a multimedia e-Learning course covering the same content (e-DBT), and (c) a placebo control e-Learning course (e-Control). Participants were randomized to a condition, and the training took place in a highly structured and controlled learning environment. Assessments were completed at baseline, post-training, and 2, 7, 11, and 15 weeks following training. The results indicate that one or both of the active DBT conditions outperformed the control condition on all outcomes except motivation to learn and use the treatment. While clinicians preferred e-DBT over the Manual and found it more helpful and engaging, the active DBT conditions generally did not differ on the primary outcomes of knowledge and self-efficacy, with the exception that e-DBT significantly outperformed the Manual on knowledge at the 15-week follow-up. E-DBT also produced the highest rate of applying and teaching the newly learned skills in clinical practice. Overall, results from this study support the efficacy of e-Learning in disseminating knowledge of empirically supported treatments to clinicians, while also indicating that treatment manuals can be effective training tools.

Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial

Relapse prevention for bipolar disorder increases time to relapse but is not available in routine practice. To determine the feasibility and effectiveness of training community mental health teams (CMHTs) to deliver enhanced relapse prevention. In a cluster randomised controlled trial, CMHT workers were allocated to receive 12 h training in enhanced relapse prevention to offer to people with bipolar disorder or to continue giving treatment as usual. The primary outcome was time to relapse and the secondary outcome was functioning. Twenty-three CMHTs and 96 service users took part. Compared with treatment as usual, enhanced relapse prevention increased median time to the next bipolar episode by 8.5 weeks (hazard ratio 0.79, 95% CI 0.45-1.38). Social and occupational functioning improved with the intervention (regression coefficient 0.68, 95% CI 0.05-1.32). The clustering effect was negligible but imprecise (intracluster correlation coefficient 0.0001, 95% CI 0.0000-0.5142). Training care coordinators to offer enhanced relapse prevention for bipolar disorder may be a feasible effective treatment. Large-scale cluster trials are needed.

China–Australia–Hong Kong tripartite community mental health training program

AbstractThe present paper describes the unique mental health training cooperation between two countries involving three training sites to facilitate the improvement of mental health care and service delivery in China. The priority is to build workforce capacity to deliver appropriate mental health care and rehabilitation in the community. In response to this challenge, a training program was collaboratively planned between partners in both countries to provide a comprehensive training program for multiskilled case workers for mainland China. The development and key activities of the training and exchange program correspond to a diverse range of training programs across multiple levels of staff and sectors. The tripartite training program represents a unique, large scale training program that has contributed significantly to developing one of the largest global national mental health program of reform and building a national community mental health service system for China. Over their many years of cooperation, the Australian and Chinese partners have developed a model for successful collaboration, one based on mutual respect, exchange of expertise and a deep appreciation of cultural difference and its influences on broad aspects of health system development.

Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills

This study evaluated the efficacy of three methods of training community mental health providers (N = 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satisfaction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians' ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods.

Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial

Community mental health nurses (CMHNs) are the backbone of specialist mental health services in the UK. This study evaluated the effects of training CMHNs in a systematic psychosocial intervention (PSI), to help family carers manage behavioural changes in their relative with dementia. One hundred and thirteen family carers received PSI support from a 'trained' (experimental), or a 'usual practice' (control) CMHN. Primary (day-to-day behaviour problems and management) and secondary (carer mood) outcome measures were obtained at baseline, 6, 12 and 18 months. CMHN training and supervision commenced prior to, and continued throughout, the 18-month study. Patient cognition declined in both groups, but problem behaviour reduced in experimental group families. However this effect was associated with the practice of some, not all, CMHNs. Carer management and mood improved with PSI support. In contrast, by 18 months, families supported by conventional CMHNs reported reduced coping resources, increased problem behaviour and their level of depression worsened. Only two CMHNs adhered to the PSI-protocol. Some, but not all, 'trained' CMHNs used the PSI to help family carers reduce behavioural problems. A relatively long but not intensive PSI of 12-18 months was needed to moderate carer mood. Dementia-specific practice arrangements, training and sustained clinical supervision are important for the delivery of effective psychosocial interventions in dementia.