Behavioral Activation (BA) is an important therapeutic intervention for major depressive disorder (MDD) that already has substantial evidence of its effectiveness particularly with severe cases of MDD. There are currently reliable and valid observer rated measures of adherence and competence to BA techniques, but like most measures designed to assess adherence and competence within an efficacy context, these measures are costly and time consuming. Although the past decade has shown a concerted effort to disseminate efficacious psychotherapies to community settings, there are few reliable and efficient measures to assess the quality of psychotherapy delivery in these community settings. Our goal is to develop clinician and consumer pragmatic measures of BA quality that are reliable, feasible, and acceptable in a community mental health setting. We will develop clinician and consumer measures and will collect a prospective feasibility sample to insure that our measure is reliable, feasible, and acceptable in the community mental health setting. We will work with experts and community stakeholders to develop a pool of self-report items feasible in the community setting. We will have experts in BA rate each of the items from audiotaped recordings of treatment sessions from our current effectiveness trial of BA in the community setting. We will select reliable items that predict symptom course and target change for our final clinician and consumer quality measures to insure that we develop quality measures that capture the important aspects of BA quality. We will have both clinicians previously trained to competence in BA as part of an effectiveness trial and consumers seeking treatment for depression in the community rate the new pragmatic assessments of BA quality on tablet computers that allow for instant electronic capture following outpatient sessions. Finally, we will assess the acceptability of our new pragmatic BA quality assessments from the perspective of community stakeholders. BA is an obvious fit for improving care in CMHCs and shows great promise as a treatment for depression but reliable and valid pragmatic measures of BA quality are needed to support disseminations efforts.
Major depressive disorder is a severe and disabling disorder afflicting 7% of individuals in the United States annually and approximately 17% of individuals across their lifetime. Although Behavioral Activation is an effective intervention that could improve outcomes in community practice, there are no reliable and efficient measures to assess the quality of Behavioral Activation in community settings. This application proposes a program of research to develop a pragmatic measure of Behavioral Activation Quality to aid in efficiently disseminating this important treatment for consumers with major depressive disorder seeking care in community mental health settings.
