Influences on the Sustainability of Evidence-Based Psychotherapies

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The applicant is proposing funding through the Pathway to Independence Career Development Award (K99) to conduct a program of training and research that will to develop skills in mixed-methods research strategies and knowledge of theories of dissemination and organizational change. The applicant will interface clinical intervention research and organizational research to determine barriers to the sustained use of empirically supported psychotherapies after training occurs within community mental health agencies. The proposed research projects will complement the training program by providing opportunities to implement the mixedmethods strategies to assess barriers to sustained implementation of empirically supported treatments within community based-settings. Mentors at two NIMH-funded research centers at Penn, both of which have developed collaborative relationships with mental health agencies in Philadelphia, will support the applicant in the proposed research and training. The first study will employ surveys to examine some hypothesized barriers to the sustainability of new interventions in community mental health settings, as well as microethnographic methods to generate more specific hypotheses regarding barriers specific to these settings. The second study will examine the natural trajectory of the use of cognitive therapy after training in community mental health settings over two years. The relationship between clinician attitudes towards CT, specific organizational factors, and the sustained adoption of CT will be examined using a mixed-methods strategy. A secondary goal of this research will be to conduct the first examination the "real world" modifications that the treatment protocol undergoes as a result of the needs of the client and the realities of clinical practice. These results will inform the development of an RO1 to test a model of the individual and organizational factors that predict the sustainability of adoption within community mental health settings. This research program will yield some of the first data regarding the organizational and individual factors that impact the long-term sustainability of evidence-based psychotherapies. The knowledge gained can lead to the implementation of interventions that appropriately address barriers to the use of evidence-based therapies in community settings, which will in turn promote increased access to interventions that, despite extensive empirical support, currently are not widely available to community mental health consumers