Abstract
This study examined stakeholder perceptions of the “fit” between cognitive-behavioral social skills training (CBSST) and assertive community treatment (ACT) when implementing CBSST into existing community-based ACT teams. Focus group feedback was collected from a diverse set of stakeholders (i.e., clients, providers, supervisors, agency administrators, public sector representatives, and intervention developers). Results identified perceived client and provider benefits for integrating CBSST into ACT while highlighting the importance of purposeful adaptations, training, and implementation tools to facilitate structural and values fit between CBSST and ACT. Study findings will inform future endeavors to implement CBSST and other relevant EBPs into ACT. Trial Registry: ClinicalTrials.gov #NCT02254733.
Similar content being viewed by others
References
Aarons, G. A., Green, A. E., Palinkas, L. A., Self-Brown, S., Whitaker, D. J., Lutzker, J. R., et al. (2012). Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science, 7, 32. https://doi.org/10.1186/1748-5908-7-32.
Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.
Allness, D. J., & Knoedler, W. H. (1998). The PACT model of community-based treatment for persons with severe and persistent mental illnesses: A manual for PACT start-up. NAMI Campaign to End Discrimination, NAMI Anti Stigma Foundation.
Burroughs, T., & Somerville, J. (2013). Utilization of evidenced based dialectical behavioral therapy in assertive community treatment: Examining feasibility and challenges. Community Mental Health Journal, 49(1), 25–32.
Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd edn.). Thousand Oaks: Sage.
Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217–226.
Dixon, L. B., Dickerson, F., Bellack, A. S., Bennett, M., Dickinson, D., Goldberg, R. W., et al. (2010). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin, 36(1), 48–70.
Drake, R. E., Bond, G. R., & Essock, S. M. (2009). Implementing evidence-based practices for people with schizophrenia. Schizophrenia Bulletin, 35(4), 704–713.
Ehrhart, M. G., Aarons, G. A., & Farahnak, L. R. (2014). Assessing the organizational context for EBP implementation: The development and validity testing of the implementation climate scale (ICS). Implementation Science, 9, 157. https://doi.org/10.1186/s13012-014-0157-1.
Gaebel, W., Weinmann, S., Sartorius, N., Rutz, W., & McIntyre, J. (2005). Schizophrenia practice guidelines: International survey and comparison. British Journal of Psychiatry, 187(1), 248–255.
Granholm, E., Holden, J., Link, P. C., McQuaid, J. R., & Jeste, D. V. (2013). Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: Defeatist performance attitudes and functional outcome. The American Journal of Geriatric Psychiatry, 21(3), 251–262.
Granholm, E., Holden, J. L., Sommerfeld, D., Rufener, C., Perivoliotis, D., Mueser, K., & Aarons, G. A. (2015). Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: Study protocol for a randomized controlled trial. Trials, 16(1), 438.
Granholm, E., McQuaid, J. R., McClure, F. S., Auslander, L. A., Perivoliotis, D., Pedrelli, P., & Jeste, D. V. (2005). A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. American Journal of Psychiatry, 162, 520–529.
Granholm, E., McQuaid, J. R., McClure, F. S., Link, P. C., Perivoliotis, D., Gottlieb, J. D., & Jeste, D. V. (2007). Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. Journal of Clinical Psychiatry, 68(5), 730–737.
Granholm, E. L., McQuaid, J. R., & Holden, J. L. (2016). Cognitive-behavioral social skills training for schizophrenia: A practical treatment guide. New York: Guilford.
Granholm, E. L., McQuaid, J. R., Link, P. C., Fish, S., Patterson, T., & Jeste, D. V. (2008). Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia. Schizophrenia Research, 100(1), 133–143.
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581–629.
Haddock, G., Devane, S., Bradshaw, T., McGovern, J., Tarrier, N., Kinderman, P., & Harris, N. (2001). An investigation into the psychometric properties of the Cognitive Therapy Scale for Psychosis (CTS-Psy). Behavioural & Cognitive Psychotherapy, 29, 221–233.
Horner, R., Blitz, C., & Ross, S. (2014). The importance of contextual fit when implementing evidence-based interventions. Washington, DC: U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation.
Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. The Academy of Management Review, 21(4), 1055–1080.
Kurtz, M. M., & Mueser, K. T. (2008). A meta-analysis of controlled research on social skills training for schizophrenia. Journal of Consulting and Clinical Psychology, 76(3), 491.
Lehman, A. F., Steinwachs, D. M., Dixon, L. B., Postrado, L., Scott, J. E., Fahey, M., et al. (1998). Patterns of usual care for schizophrenia: Initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophrenia Bulletin, 24(1), 11.
Mojtabai, R., Fochtmann, L., Chang, S. W., Kotov, R., Craig, T. J., & Bromet, E. (2009). Unmet need for mental health care in schizophrenia: An overview of literature and new data from a first-admission study. Schizophrenia Bulletin, 35(4), 679–695.
Monroe-DeVita, M., Morse, G., & Bond, G. R. (2012). Program fidelity and beyond: Multiple strategies and criteria for ensuring quality of assertive community treatment. Psychiatric Services, 63(8), 743–750.
Monroe-DeVita, M., Teague, G. B., & Moser, L. L. (2011). The TMACT: A new tool for measuring fidelity to assertive community treatment. Journal of the American Psychiatric Nurses Association, 17(1), 17–29.
Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24(1), 37–74.
QSR International. (2012). NVivo 10 [computer software]. Retrieved from http://www.qsrinternational.com/pr oducts_nvivo.aspx.
Salyers, M. P., McGuire, A. B., Rollins, A. L., Bond, G. R., Mueser, K. T., & Macy, V. R. (2010). Integrating assertive community treatment and illness management and recovery for consumers with severe mental illness. Community Mental Health Journal, 46(4), 319–329.
Sedlar, G., Bruns, E. J., Walker, S. C., Kerns, S. E. U., & Negrete, A. (2017). Developing a quality assurance system for multiple evidence based practices in a statewide service improvement initiative. Administration and Policy in Mental Health and Mental Health Services Research, 44(1), 29–41.
Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measure. Implementation Science: IS, 9, 7. https://doi.org/10.1186/1748-5908-9-7.
Stein, L. I., & Santos, A. B. (1998). Assertive community treatment of persons with severe mental illness. New York: Norton.
Stirman, S. W., Miller, C. J., Toder, K., & Calloway, A. (2013). Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implementation Science, 8, 65.
Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68, 216–232.
Williams, C. H. J. (2008). Cognitive behaviour therapy within assertive outreach teams: Barriers to implementation: A qualitative peer audit. Journal of Psychiatric and Mental Health Nursing, 15(10), 850–856.
Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34(3), 523–537.
Acknowledgements
We thank the participants who volunteered for this study. Research reported in this publication was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development Service, the National Institute of Mental Health of the National Institutes of Health (Grant R01MH091057-05 to Dr. Granholm). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs or National Institutes of Health. Dr. Granholm has an equity interest in Granholm Consulting, Inc., a company that may potentially benefit from the research results as he receives income from the company for CBSST workshops and consulting and royalties for a CBSST book. The terms of this arrangement have been reviewed and approved by the University of California, San Diego in accordance with its conflict of interest policies.
Funding
This study was funded by the Veterans Medical Research Foundation (5R01MH091057-05).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
David H. Sommerfeld, Gregory A. Aarons, Jeanean Naqvi, Dimitri Perivoliotis and Kim Mueser declare that they have no conflict of interest. Jason Holden conducts CBSST training workshops as a paid consultant and receives royalties from Guildford Press for CBSST book sales. Eric Granholm conducts CBSST training workshops as a paid consultant through Granholm Consulting Inc. and receives royalties from Guildford Press for CBSST book sales.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Sommerfeld, D.H., Aarons, G.A., Naqvi, J.B. et al. Stakeholder Perspectives on Implementing Cognitive Behavioral Social Skills Training on Assertive Community Treatment Teams. Adm Policy Ment Health 46, 188–199 (2019). https://doi.org/10.1007/s10488-018-0904-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-018-0904-8