Journal Article

Feasibility and acceptability of two incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: a pilot study to inform a randomized controlled trial

Beidas, Rinad S., Williams, Nathaniel J., Adams, Danielle R., Richey, Elizabeth, Marcus, Steven C., Wolk, Courtney Benjamin, Becker-Haimes, Emily M., Skriner, Laura, Buttenheim, Alison M., Stewart, Rebecca E., Inacker, Patricia

2017

Overview

Background Informed by our prior work indicating that therapists do not feel recognized or rewarded for implementation of evidence-based practices, we tested the feasibility and acceptability of two incentive-based implementation strategies that seek to improve therapist adherence to cognitive-behavioral therapy for youth, an evidence-based practice. Methods This study was conducted over 6 weeks in two community mental health agencies with therapists ( n  = 11) and leaders ( n  = 4). Therapists were randomized to receive either a financial or social incentive if they achieved a predetermined criterion on adherence to cognitive-behavioral therapy. In the first intervention period (block 1; 2 weeks), therapists received the reward they were initially randomized to if they achieved criterion. In the second intervention period (block 2; 2 weeks), therapists received both rewards if they achieved criterion. Therapists recorded 41 sessions across 15 unique clients over the project period. Primary outcomes included feasibility and acceptability. Feasibility was assessed quantitatively. Fifteen semi-structured interviews were conducted with therapists and leaders to assess acceptability. Difference in therapist adherence by condition was examined as an exploratory outcome. Adherence ratings were ascertained using an established and validated observational coding system of cognitive-behavioral therapy. Results Both implementation strategies were feasible and acceptable—however, modifications to study design for the larger trial will be necessary based on participant feedback. With respect to our exploratory analysis, we found a trend suggesting the financial reward may have had a more robust effect on therapist adherence than the social reward. Conclusions Incentive-based implementation strategies can be feasibly administered in community mental health agencies with good acceptability, although iterative pilot work is essential. Larger, fully powered trials are needed to compare the effectiveness of implementation strategies to incentivize and enhance therapists’ adherence to evidence-based practices such as cognitive-behavioral therapy.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adolescent / Adult / Behavior modification / Behavioral economics / Behavioral medicine / Child / Clinical trials / Cognitive Behavioral Therapy - methods / Cognitive Behavioral Therapy - organization & administration / Cognitive Behavioral Therapy - standards / Cognitive-behavioral therapy / Community mental health / Community Mental Health Services - organization & administration / Community Mental Health Services - standards / Evidence-based medicine / Evidence-Based Practice / Evidence-based practices / Female / Guideline Adherence / Health Administration / Health Informatics / Health Policy / Health Promotion and Disease Prevention / Health Services Research / Humans / Incentives / Interviews as Topic / Male / Medicine / Medicine & Public Health / Mental Disorders - therapy / Mental health / Middle Aged / Motivation / Pilot Projects / Practice Guidelines as Topic / Public Health / Research Design