Sarfan Laurel D, Bajwa Zia, Diaz Marlen, Tiab Sondra, Fisher Krista, Agnew Emma R, Howlett Shayna A, Oliver Sophia, Callaway Catherine A, Harvey Allison G
Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Adm Policy Ment Health. 2025 Mar;52(2):318-330. doi: 10.1007/s10488-024-01410-1. Epub 2024 Sep 9.
Community mental health centers (CMHCs) offer invaluable, publicly-funded treatment for serious mental illness (SMI). Unfortunately, evidence-based psychological treatments are often not delivered at CMHCs, in part due to implementation barriers, such as limited time, high caseloads, and complex clinical presentations. Transdiagnostic treatments may help address these barriers, because they allow providers to treat symptoms across multiple disorders concurrently. However, little research has investigated CMHC providers' experiences of delivering transdiagnostic treatments "on the ground," particularly for adults with SMI. Thus, the aim of the present study was to assess CMHC providers' perspectives on delivering a transdiagnostic treatment - the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) - to adults diagnosed with SMI. In the context of a larger parent trial, providers were randomized to deliver a standard version of TranS-C (Standard TranS-C) or a version adapted to the CMHC context (Adapted TranS-C). Twenty-five providers from the parent trial participated in a semi-structured interview (n = 10 Standard TranS-C; n = 15 from Adapted TranS-C). Responses were deductively and inductively coded to identify themes related to Proctor's taxonomy of implementation outcomes. Four novel "transdiagnostic take homes" were identified: (1) transdiagnostic targets, such as sleep, can be perceived as motivating and appropriate when treating SMI, (2) strategies to bolster client motivation/adherence and address a wider range of symptom severity may improve transdiagnostic treatments, (3) balancing feasibility with offering in-depth resources is an important challenge for transdiagnostic treatment development, and (4) adapting transdiagnostic treatments to the CMHC context may improve provider perceptions of implementation outcomes.
社区心理健康中心（CMHCs）为严重精神疾病（SMI）提供了宝贵的公共资助治疗。不幸的是，循证心理治疗在CMHCs中往往无法提供，部分原因是存在实施障碍，如时间有限、工作量大以及临床表现复杂。跨诊断治疗可能有助于克服这些障碍，因为它们使治疗师能够同时治疗多种疾病的症状。然而，很少有研究调查CMHCs治疗师在实际提供跨诊断治疗方面的经验，特别是针对患有SMI的成年人。因此，本研究的目的是评估CMHCs治疗师对为被诊断患有SMI的成年人提供一种跨诊断治疗——睡眠和昼夜节律功能障碍跨诊断干预（TranS-C）——的看法。在一项更大的母试验背景下，治疗师被随机分配提供TranS-C的标准版本（标准TranS-C）或适合CMHC背景的版本（改编TranS-C）。来自母试验的25名治疗师参与了半结构化访谈（n = 10名接受标准TranS-C；n = 15名接受改编TranS-C）。对回答进行了演绎和归纳编码，以识别与普罗克特实施结果分类法相关的主题。确定了四个新的“跨诊断要点”：（1）在治疗SMI时，跨诊断目标，如睡眠，可被视为具有激励作用且合适；（2）增强客户动机/依从性并应对更广泛症状严重程度的策略可能会改善跨诊断治疗；（3）在可行性与提供深入资源之间取得平衡是跨诊断治疗开发的一项重要挑战；（4）使跨诊断治疗适应CMHC背景可能会改善治疗师对实施结果的看法。
