Category: Dissemination / Implementation

Symposium

Tailoring CBT for an Adolescent Residential Treatment Center

Friday, November 17
3:00 PM - 4:00 PM
Location: Indigo Ballroom A, Level 2, Indigo Level

Keywords: Implementation | Adolescents | Treatment Integrity / Adherence / Compliance
Presentation Type: Symposium

CBT is an empirically supported psychosocial intervention for numerous clinical issues observed in adolescent populations.  Despite its evidence base, there are few examples of CBT being used in residential treatment settings.  Although a significant step forward would be to train therapists in adolescent residential treatment centers to deliver CBT, coordination of care in these team-based treatment settings would likely optimize outcomes.  However, to successfully integrate CBT across clinical and operations staff, as well as ensure that it fits within the current day-to-day treatment program, significant adaptions are necessary.  In the context of an academic-community partnership, CBT was adapted to be delivered across staff levels at an adolescent residential treatment center.  Master’s degree level supervising therapists received weekly group CBT supervision, which included tape review of therapy sessions, and focused on learning to apply CBT flexibly according to an individualized cognitive conceptualization.  CBT was adapted to be delivered by staff with high school level education with daily integration into the treatment program, including the morning routine, school, therapy groups, and recreation time.  The CBT core skills that were deemed critical for comprehensive care were collaborative active listening (VALUE), problem solving (ITCH), rating subjective distress intensity (SPEED Map), activity scheduling (CAPES), distress tolerance (TIP), and cognitive restructuring (CBT Chat Form).  In tandem, systems were developed to support implementation with fidelity.  Supervising therapists’ session tapes were rated on the Cognitive Therapy Rating Scale. A CBT endorsement system was developed to enhance fidelity for using CBT core skills across other staff levels, which consisted of a three-level endorsement process.  In order to receive the CBT endorsement, staff had to pass a multiple-choice test on behaviorism, accurately describe the cognitive model, and use all CBT core skills with at least moderate skill as judged by a trained rater during either a role-played interaction or observed with an adolescent.  This integration of CBT across all staff levels and aspects of the treatment program can serve as an example for other team-based treatment settings.                    

Robert Hindman

Beck Institute

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