Transportability of CBT for Adolescent Depression and Suicide Prevention to Social Work Practitioners

Background and Purpose: Suicide is the third leading cause of death among adolescents. Untreated depression is the leading mental health risk factor for adolescent suicide. Over two-thirds of female and half of male suicide completers were reported to have depression at the time of their death. The majority of these adolescents were untreated. The reduction of youth suicide is dependent upon effective treatment being disseminated and implemented in community settings. Evidence is building that training community clinicians in manualized Cognitive behavioral therapy (CBT) reduces depressive symptoms, the necessity of other services, and treatment costs among depressed adolescents. Transportability and adherence to evidence-based practice (EBP) models is not without its barriers. Individual therapists may have reservations that can impede the implementation of EBP. Clinicians with less experience treating adolescents and those who lack organizational support tend to report more difficulty in accepting EBP into practice. Improving the therapist's support network may help to improve the adoption of the EBP. This study evaluates the effectiveness of a 2-day training session, accompanied by online support, discussion and group consultation, on knowledge and transportability of CBT skills into clinical practice with depressed adolescents. Methods: A purposive sample of 22 licensed clinical social workers who treat adolescents or young adults in Monmouth County, New Jersey was selected. Subjects were recruited from private practice, community based settings and hospital agencies, and were selected to represent the greatest range of practices and locations across the county. Subjects completed baseline information regarding their prior training, clinical practice, barriers to adopting evidence based practice and knowledge of CBT skills and techniques. Subjects participated in two 6-hour training sessions on the components of CBT and the skills and techniques of CBT for suicide prevention. A post-test of CBT knowledge and skills was administered following the 2 day training. Individual client contact sheets were collected for 3 months following the training to assess CBT skills used in practice. Results: There was a significant increase in clinicians' knowledge of CBT for depression and suicide prevention immediately following the training. Clinicians with less experience with CBT showed the most improvement. Individuals reported significant barriers to incorporating the skills into practice. However, this was mediated by the number of consultations and online discussions they participated in. Clinicians reported frequent use of the suicide safety plan and indicated that they felt it was one of the most helpful tools that they had learned. Other skills readily incorporated into practice were chain analysis and cognitive restructuring. Conclusions and Implications: Evidence-based treatments, such as CBT for adolescent depression and suicide prevention, can be transported into the community. Licensed clinical social workers are able to incorporate manualized evidence-based practice in their regular practices provided support is given. .