Behavioral interventions targeting cognitive and social skills such as CET and HOPES have shown strong evidence of feasibility, tolerability and efficacy for people with psychosis in clinical trials. Yet despite empirical evidence supporting use of these programs in routine clinical care, clinical availability remains sparse. A number of potential facilitators and barriers to implementation and dissemination have been identified, and a recent report highlighted that organizational elements such as training programs and embedded monitoring activities may facilitate adoption of novel behavioral interventions in clinical services.
At McLean, our experience and post-study feedback from our Project SUCCESS clinicians suggests that projects such as this not only provide key comparative effectiveness insights but may create a pathway to clinical uptake of these interventions. In keeping with the above findings, key barriers to clinical uptake of even well-tested interventions as identified by stakeholders include lack of local experts to provide training, supervision, and ongoing monitoring and support. As part of the implementation of Project SUCCESS, local sites are provided in-depth training on service delivery embedded in our existing clinical programs and serving clients already engaged in care. Additionally, the Project includes ongoing, regular supervision to enhance fidelity to the treatment, troubleshoot challenges, and keep clinicians engaged as they go through the process of learning to deliver an intervention that they have not previously used. These types of supports serve as key facilitators to uptake by providing dedicated clinician training time and supervision led by experts in the techniques being implemented, and expert guidance on roll-out of these new clinical services. Dedicated study staff time was also a major facilitator to uptake, providing support around identification of participants, ongoing participant engagement, and set-up and organization activities such as scheduling and obtaining materials and supplies.
Our clinician feedback suggests that these elements of Project SUCCESS greatly enhanced clinician confidence and engagement through training, support, “lessons learned,” and collective problem solving, and through dedicated study staff to support key logistical components and participant engagement. With the set-up and training completed, and experience delivering the full course of treatment with expert support, clinicians are now equipped to continue delivering treatment as a stand-alone clinical service. Programs like Project SUCCESS may serve as a model for development of pipelines to implementation and uptake of empirically supported treatments into routine clinical care.
Eve Lewandowski, Ph.D.
Director of Clinical Programming
McLean OnTrack
Schizophrenia and Bipolar Disorder Program
Associate Professor, Department of Psychiatry
Harvard Medical School
Josie Kolstad
Clinical Research Coordinator
McLean Hospital