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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number148
JournalImplementation Science
Volume12
Issue number1
DOIs
StatePublished - Dec 15 2017

Keywords

  • Behavioral economics
  • Community mental health
  • Evidence-based practices
  • Incentives

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Health Informatics

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