Recovery Michigan

Community mental health clinics, where most specialty mental health treatment is delivered, have been relying more on independent contractors to treat patients, largely for budgetary reasons. Many of these clinics have simultaneously been moving towards the greater use of evidence-based psychosocial practices (EBPs), broadly defined as talk therapies that are informed by rigorous research as well as clinician expertise and patient preferences. A new, first-of-its-kind study from the Perelman School of Medicine at the University of Pennsylvania suggests that these two trends may be in conflict. The findings appear this month in Psychiatric Services.

"The independent contractor therapists we surveyed turned out to have less positive attitudes towards evidence-based talk therapies for youth such as cognitive-behavioral therapy and less knowledge about them, compared with salaried employee therapists," said lead author Rinad S. Beidas, PhD, an assistant professor of Psychology in the department of Psychiatry at Penn Medicine. CBT emphasizes problem-solving and teaching youth specific skills to correct distorted thinking and change behavior.

Beidas, who is also director of Implementation Research at Penn's Center for Mental Health Policy and Services Research, has shown in previous work how attitudes, knowledge, and organizational culture influence the implementation of EBPs in public mental health clinics.

In recent decades, all healthcare disciplines have been moving towards better, more standardized care by identifying EBPs and pushing for their greater use. Specifically, the City of Philadelphia Department of Behavioral Health, led by Commissioner Arthur C. Evans, PhD, Jr, created an innovative program in 2007 to foster and support EBPs in its public mental health clinics.

Three years ago, Beidas and her colleagues began studying EBP implementation in Philadelphia. "One of the things that my team initially noticed, which we did not expect, was that there were a lot of independent contractor therapists at these agencies," Beidas said.