(PS5-C72) A Statewide Implementation Initiative to Increase the Availability of Evidence Based Treatment for Substance Use Disorders in Community Mental Health Centers

Introduction: While evidence-based treatments (EBTs) exist for substance use disorders (SUDs), a significant gap remains in the availability and accessibility of these EBTs in community SUD treatment programs. One reason for this gap is the limited workforce trained to deliver such EBTs. To address this need, a statewide implementation initiative was launched to train community-based therapists in motivational enhancement/cognitive behavioral therapy (MET/CBT), an EBT for SUDs in adolescents and adults. This study describes the structure and scope of this two-year statewide initiative and therapist engagement and training outcomes.

Method: Two cohorts of community-based therapists (N = 93; cohort 1: n = 65, cohort 2: n = 28) who provide therapy to patients with SUDs participated in a two-day MET/CBT training workshop followed by six months of biweekly clinical consultation from national MET/CBT experts, fidelity monitoring, and guided readings and online resources. Pre-implementation changes (e.g., introducing formal agreements, a free account for an AI-based platform that provides HIPAA compliant session recording and storage) were made for cohort 2 to address barriers identified and feedback provided by cohort 1 therapists. Therapists completed pre-training and follow-up assessments measuring knowledge, attitudes, confidence, training helpfulness, and implementation barriers. Linear mixed models, Mann-Whitney U tests, and Wilcoxon Signed Rank tests were performed to evaluate pre- to post-training changes in training outcomes.

Results: The majority of therapists (cohort 1: 75%, cohort 2: 73.5%) attended 10 or more consultation calls, with submission of MET/CBT session recordings for personalized feedback the least utilized training element (cohort 1: 3.1%, cohort 2: 17.9%). Significantly more therapists in cohort 2 submitted session recordings (p = .02), but participation was still low, even with the addition of extra troubleshooting and a free HIPAA compliant recording and storage account. Regarding training outcomes, therapists reported increased confidence in their ability to implement MET/CBT for SUD (M = 7.5 out of 10) and demonstrated improvement in MI (0.09 [95% CI, 0.03 to 0.16], p< .01) and CBT (0.12 [95% CI, 0.03 to 0.20], p< .01) knowledge pre- to post-training. Therapists did not show a change in attitudes towards evidence-based practices (p’s > .31), likely due to ceiling effects. Therapists reported encountering several implementation barriers, including lack of time and opportunity to treat patients with MET/CBT and policy issues within the agency.

Discussion: Improvements in knowledge and confidence were observed. Few recordings were submitted by therapists, which limited our ability to measure MET/CBT implementation and fidelity outcomes, highlighting an important goal for future research. Future training initiatives should consider incentivizing adherence to all training components (e.g., recordings) and evaluate patient outcomes. Additional considerations are discussed.