Attitude: The Health Professionals’ Mindset While Implementing Cognitive Behavioral Therapy for Psychosis Stepped Care (CBTp-SC)

Abstract

Brief Introduction: Delivering high-quality and consistent service is a challenge to health professionals working in community behavioral health agencies. Attitudes can affect positive or negative outcomes in the implementation of new services, such as Cognitive Behavioral Therapy for psychosis stepped-care (CBTp-SC), an evidence-based practice for improving symptom management among patients with psychosis. Significance: Although organizational and leadership support play an important role in successful implementation of CBTp-SC in community behavioral agencies, attitudes of providers towards such evidence-based practices cannot be addressed directly by leadership alone. Attitudes include health professionals engaging in supervision, training and adhering to structural treatment fidelity with an open mind. Understanding attitudes towards CBTp-SC can inform refinements of implementation strategies. Purpose: The primary objective was to summarize attitudes of health professionals regarding the acceptability, appropriateness and feasibility of CBTp-SC. Secondary objectives included examining variance of these attitudes across characteristics of health professionals, and summarizing perspectives on usefulness, challenges, and effectiveness of CBTp-SC. Study population: The study population included health professionals working in community behavioral health agencies who were trained by the University of Washington in the last five years to administer CBTp-SC . Methods: This study is a cross-sectional study that used a web-based questionnaire. Forty-six health professionals completed a 30-item online questionnaire. Items consisted of questions to assess acceptability, appropriateness, and feasibility of CBTp-SC. Additional items measured usefulness of CBTp-SC, challenges in applying CBTp-SC, and ability of CBTp-SC to address problems and/or conditions. One-way ANOVA was used to examine variations in acceptability, appropriateness and feasibility of CBTp-SC across provider characteristics. All analysis was performed using R and excel for data management, statistical analysis, and figures. Statistical significance was defined for p-values less than 0.05. Results: Findings indicate that health professionals trained in CBTp-SC found it acceptable, appropriate, and feasible to deliver within community behavioral health settings. However, there was slightly more variability for feasibility with lower mean scores for two of the four items used to measure this construct. We did not detect statistically significant variation in attitudes towards these three constructs across provider characteristics. Health professionals, on average, rated CBTp-SC as moderately useful and effective and moderately challenging to apply. Conclusion: This study provides evidence that health professionals generally find referring and providing CBTp-SC as acceptable and appropriate in community behavioral health settings. Further research is needed to examine feasibility of providing CBTp-SC in community behavioral health agencies and whether feasibility accounts for attitudes impacting delivery of CBTp-SC to patients with schizophrenia spectrum disorder.