Executive Summary
Coalition for the Advancement and Application of Psychological Science (CAAPS) Multidisciplinary Mental Health Summit II
October 21-22, 2019
CAAPS Summit Planning Committee:
Bethany Teachman, Summit Chair
Mitch Prinstein
Dean McKay
Tammy Schuler
Jason Washburn
Jordana Muroff
Doug Mennin
With input from: Evie Garcia; Kristin Powell
Overview:
In September 2018, the first CAAPS mental health summit was convened to discuss how a wide range of professional mental health and patient advocacy groups view evidence-based practice (EBP) decision making and consider whether these groups could find common ground in their perspectives about EBP. This year’s meeting continued this discussion with a specific focus on challenges and opportunities when applying different views of evidence based practice decision making in the treatment of marginalized and underserved populations.
The summit was hosted at the American Psychological Association’s Spire Center in Washington, DC. Attendees included a wide array of representatives from mental and medical health organizations, stakeholder groups, experts in the field, foundations, government agencies, and more.
The event was co-sponsored by the following organizations:
American Psychological Association
Annie E. Casey Foundation
Society of Clinical Child and Adolescent Psychology
Summit Goals:
Four broad goals for the summit were:
Increase understanding of different conceptualizations of evidence-based practice (EBP) approaches when working with diverse, underserved populations
Increase understanding of barriers to and opportunities for implementing EBP decision making when working with diverse, underserved populations (across stakeholders)
Discuss ways to address barriers to and opportunities for collaboration across groups to address service delivery gaps, and clarify what we can add
Discuss opportunities for funding for the science needed to address our gaps in knowledge
Overview of Presentations and Discussion:
Day 1 Presentations:
Understanding different perspectives on evidence-based practice (EBP) and recognizing challenges when applying traditional EBP models with underserved populations: Focus on Clinical Practice Guidelines
Facilitated by Dr. Lynn Bufka, Associate Executive Director, Practice Research and Policy, American Psychological Association
Conceptual issues when adapting and scaling traditional EBP research paradigms with underserved populations: Focus on the Philadelphia’s Department of Behavioral Health and Intellectual disAbility Service
Facilitated by Dr. Arthur Evans, American Psychological Association CEO
and Panel Representatives from Philadelphia’s Department of Behavioral Health and Intellectual DisAbility Service:
Dr. Torrey Creed, Assistant Professor of Psychology in Psychiatry Perelman School of Medicine, University of Pennsylvania Director, The Penn Collaborative for CBT and Implementation Science, Health and Policy
Dr. Ronnie Rubin, Impact Reach, LLC
Ms. Carrie Comeau, Advisor, Partners in Health, Director of the Evidence-Based Practice and Innovation Center (EPIC)
Dr. Paul Grant, Director, Beck Institute Center for Recovery-Oriented Cognitive Therapy, The Beck Institute
Mr. Antonio Valdés, Chief Executive Officer at Children's Crisis Treatment Center
Dr. Rebecca Stewart, Center for Mental Health Department of Psychiatry University of Pennsylvania Perelman School of Medicine
In addition, two videos were presented, each featuring an individual with lived experience describing their experiences receiving care in the EPIC system. Dr. Grant introduced a video of Dr. Beck discussing the Beck Institute’s involvement in community-based initiatives.
Lessons learned from Community Participant Research
Facilitated by Dr. Sherry Molock, Associate Professor Department of Psychology George Washington University
Lessons Learned from Cultural Adaptation Science
Facilitated by Dr. Jordana Muroff, Associate Professor School of Social Work Boston University
Lessons Learned from Global Mental Health Initiatives
Facilitated by Dr. Yulia Chentsova-Dutton, Associate Professor, Cultural Psychology, Georgetown University; and Dr. Brandon Kohrt, Charles and Sonia Akman Professor of Global Psychiatry; Associate Professor of Psychiatry, Global Health, and Anthropology; Director, Division of Global Mental Health, The George Washington University
Day 2 Presentations:
Culture and Coloniality in Indigenous Community Mental Health: Considering AlterNative Orientations and Perspectives
Facilitated by Dr. Joseph Gone, President Elect, Society of Indian Psychologists; Faculty Director, Harvard University Native American Program; Professor of Anthropology and of Global Health and Social Medicine, Harvard University
Systemic issues tied to payment and care delivery systems that maintain health inequities
Facilitated by Dr. Scott Cook, Co-Director - Advancing Health Equity: Leading Care, Payment, and Systems Transformation (a program of the Robert Wood Johnson Foundation), Department of Medicine, University of Chicago, Quality Improvement and Care Transformation, Strategist - Department of Diversity, Inclusion, and Equity, U. Chicago Medicine
Funding for research to address key gaps in our knowledge
Facilitated by Dr. Andrea Beckel-Mitchener, Director, Office for Disparities Research and Workforce Diversity & Office of Rural Mental Health Research at NIMH
Summary of Major Themes Raised during discussions
When discussing how we present information to different audiences (including the public, persons with lived experience and their families, providers, etc.), the group discussed ways to more deeply situate the presentation of EBP materials within a cultural lens. For instance, the group provided very helpful feedback about the need to more clearly recognize a broader range of types of providers and disciplines, and the need to strengthen messages about the importance of examining the fit of evidence within a given context and community, and the need to empower those receiving services, among other recommendations. The challenge of advocating for EBP in contexts where access to care and choice of care are seriously limited was also raised. (These recommendations were discussed in the context of viewing a draft version of a video depicting the contents of a Patient Bill of Rights.)
The need to value different ways of knowing (beyond RCTs) was discussed and the need to recognize outcomes that community members care about (e.g., indicators of functioning).
There was also discussion of who determines what outcomes matter, and the need to more clearly value community members’ voice as partners.
The need for different paradigm shifts was considered, such as the idea that we overemphasize the tools we use (e.g., a given treatment package) and don’t give enough consideration to the provider.
Questions were raised about both successes and challenges when providing services to communities of color, and the issues surrounding using EBPs that have not been well studied with those communities.
The challenges of balancing "scientific rigor" and fully engaging community partners in the research, particularly when facing peer-review, were raised, along with questions about what should count as scientific rigor.
Issues tied to the challenge of encouraging communities to determine the choice of care they want while also trying to prevent choices that could have iatrogenic effects were discussed.
The need to include strong representation from community members and persons with lived experience when developing the research and its practice applications was a recurring focus.
The critical need to diversify the mental health workforce was raised repeatedly, as was the need to examine one’s own biases.
The importance of having grant and manuscript reviewers who are sufficiently familiar with community participant research to provide meaningful reviews was also stressed.
Conclusion:
The multidisciplinary mental health summit provided a unique opportunity to bring together representatives from more than 40 organizations. At the first CAAPS summit, the first consensus statement between many different disciplines that articulates the components of EBP decision making was developed. This was a critical step but important voices were not well represented in that process, and key issues were overlooked tied to addressing biases and misinformation regarding EBP implementation as it relates to marginalized populations and communities with high levels of health disparities. As such, the topic of this year’s summit was focused on opening a dialogue between different stakeholders to discuss ways to more fully consider contextual and cultural considerations in the context of EBP decision making.
Over two days, there were interesting and provocative presentations and subsequent discussions that helped promote an open dialogue about how, historically, EBP research and implementation endeavors, have often ignored community, cultural, contextual, and institutionalized and systemic racism, bias, and discrimination factors when applying EBPs across settings.
Repeatedly, the discussion returned to the idea of valuing science AND context, and the need to stop viewing them as opposing.
There was a helpful discussion about possible next steps and ways to translate the ideas discussed during the summit into action steps, but also recognition that ongoing relationship building was needed to determine how to most effectively work together. A suggestion was made to have working groups formed at the next summit to work on some of the ideas raised.
Some potential future deliverables include:
Revise the EBP Patient Bill of Rights video.
Set action items for different domains (e.g., research, training, various practice domains, etc.) to make the EBP consensus statement components actionable and digestible.
Consider drafting a joint statement noting the importance of the knowledge we do have, acknowledgment of its limitations, and advice about how to determine if/when it make sense to generalize from data gathered in different contexts/with different populations to a new context/population that has not been well-studied.
Facilitate collaboration across groups. For instance, we could create a shared spreadsheet where each organization can note key initiatives it is working on, contact information, and potential opportunities for partnerships tied to key areas linking EBP decision making and underserved populations. Topics that could be part of the spreadsheet include:
task shifting/supporting non-specialist providers;
enhancing workforce diversity;
supporting cultural adaptation science;
training in cultural competency;
advocating for funding for research with underserved pop’n;
community-based participant research;
assessment of functioning and patient-selected outcomes; etc.
4. Encourage greater transparency in reporting on the background of providers, the cultural and economic context of studies, the prior knowledge or relationship of providers and beneficiaries, and the involvement of the community in the selection-design- implementation for psychological treatments.
5. Develop webinars, panels, white paper or other products focused on how to think about respecting different community approaches while also guarding against iatrogenic effects.
5. Consider joint efforts to recruit underrepresented students into the mental health field.
The following organizations had representatives at the summit:
Academy for Eating Disorders
Alliance of National Psychological Associations for Racial and Ethnic Equity
American Academy of Child and Adolescent Psychiatry
American Arab, Middle Eastern, North African Psychological Association
American Association of Marriage and Family Therapy
American Counseling Association
American Psychiatric Association
American Psychiatric Nurses Association
American Psychological Association
Annie E. Casey Foundation
Anxiety and Depression Association of America
Association for Behavioral and Cognitive Therapies
Association of Black Psychologists, Inc.
Beck Institute Center for Recovery-Oriented Cognitive Therapy'
Boston University
Coalition for the Advancement and Application of Psychological Science
Children’s Crisis Treatment Center
Council of University Directors of Clinical Psychology
Council on Social Work Education
Evidence-Based Practice and Innovation Center at the Dept. of Behavioral Health and Intellectual disAbility Services & Community Behavioral Health
Georgetown University
George Washington University
Impact Reach, LLC
Louisville OCD Clinic
Mental Health America
National Alliance on Mental Illness
National Association of School Psychologists
National Association of Social Workers
National Institute of Mental Health Office for Disparities Research and Workforce Diversity & Office of Rural Mental Health Research
Psychological Clinical Science Accreditation System
Society for a Science of Clinical Psychology
Society for the Psychology of Sexual Orientation and Gender Diversity Society of Behavioral Medicine
Society of Clinical Child and Adolescent Psychology
Society of Indian Psychologists
Substance Abuse and Mental Health Services Administration
University of Pennsylvania, The Penn Collaborative for CBT and Implementation Science U.S. Department of Veterans Affairs
University of California, Berkeley & Redwood Center for Cognitive Behavior Therapy and Research
University of Chicago
University of Pennsylvania