U.S. Department of Veterans Affairs National Center for PTSD
Boston University School of Medicine, USA
What does your research focus on?
My research focuses on the implementation of evidence based practices in mental health. I’m particularly interested in two areas: training and sustainability. My collaborators and I are trying to determine the best methods of training clinicians to deliver new treatments. We also need to know more about what makes implementation efforts successful over the long-term. I would like to identify the factors that are most central to sustaining evidence-based practices. As first steps, I’ve conducted a systematic review of the literature on sustainability from other fields and I’m conducting a study that follows clinicians who received training in cognitive therapy over two years to learn what influences their use of the treatment over time.
What drew you to this line of research? Why is it exciting to you?
I was first drawn to this area because I was interested in the differing perspectives on evidence based practices in psychotherapy. I started to wonder what makes some treatments and practices become routine, while others aren’t adopted at all. I started reading Everett Rogers’ Diffusion of Innovations and that made me decide to focus my own research on dissemination and implementation. Researchers are studying implementation in a variety of disciplines, and theories and methods from these areas are now being applied and tested for mental health interventions. Every time I go to a conference on implementation or search the literature, I find out about some new or interesting methods and studies. It’s still a relatively new field and there are a lot of opportunities to develop and grow as a researcher.
Who were/are your mentors or psychological influences?
I couldn’t have asked for better mentors and collaborators. Robert DeRubeis was my advisor in my PhD program, and Paul Crits-Christoph, Aaron Beck, and John Kimberly were the mentors on my K award. Their thinking influenced me tremendously and they each provided me with opportunities to advance my program of research. The consultants on my K award and more recently, several members of the faculty of the NIMH/VA Implementation Research Institute have also been critical to my training and have influenced my implementation research program. And now that I’m working in the VA system, Martin Charns and Brian Mittman have been influencing the way I think about implementation within a large healthcare system.
To what do you attribute your success in the science?
I think that the training and mentoring I’ve had has been absolutely critical. Researchers in this field have been very invested in training and mentoring new investigators. In the work I’m doing now, strong collaborations with clinicians and policymakers have also been essential–it’s not possible to do this research without it.
What’s your future research agenda?
I would like to figure out which methods of training providers in new treatments are most effective, efficient, and scalable. Right now, the evidence suggests that didactic training isn’t sufficient—some form of follow up support, like consultation or coaching, appears to be critical. However, we don’t yet know what the best form of follow-up support is or how much is necessary. Also, we know that just training clinicians isn’t enough—a number of other factors determine whether interventions will be sustained. I’m hoping to identify interventions that promote the continued use of interventions after initial training and implementation.
Finally, I’m working on developing a more efficient way to monitor fidelity to cognitive behavioral therapies, and on understanding the nature and impact of modifications that clinicians make to psychosocial treatment protocols when they implement them in routine practice.
Any advice for even younger psychological scientists? What would you tell someone just now entering graduate school or getting their PhD?
Seek out good mentors and opportunities for training and feedback. Don’t be afraid to ask for the help you need (but don’t be offended if you don’t always get it, just keep looking–people are busy!). Find research questions that really interest and excite you. Try to balance long-term, more ambitious projects with research that you can publish in the shorter term. Early in your career, work on building mutually beneficial collaborations. Collaborate with other junior investigators–it can be beneficial for everyone.
What publication are you most proud of or feel has been most important to your career?
Stirman, S. W., Crits-Christoph, P, & DeRubeis, R. (2004). Achieving successful dissemination of empirically supported adult psychotherapies: A synthesis of dissemination theory. Clinical Psychology: Science and Practice, 11, 343-359.
This was my first paper on dissemination and implementation. Although my thinking has evolved somewhat, this paper really helped me to think through the direction I wanted to take my research.
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