The goal of Community Psychiatry PRIDE is to increase the access to and quality of mental health care in community-based agencies across Massachusetts. In many poor communities, such as Chelsea where Community Psychiatry PRIDE is based, people are stuck with crime, violence, and poverty, and thus are more vulnerable to mental health disorders such as depression, anxiety and post-traumatic stress disorder. Adequate and effective health care is often not provided to these communities in need. Community Psychiatry PRIDE conducts research exploring the disproportionate mental health burden in under-served and resource-constructed communities. Through one project specifically–leveraging routine clinical materials and mobile technology to assess CBT quality–Community Psychiatry PRIDE aims to relieve this mental health burden by developing an instrument to evaluate and improve the quality of evidence-based treatments of multiple mental disorders.
Cognitive behavioral therapies (CBT) have been proven to be effective for a wide variety of psychiatric diagnoses, and have been used as a first-line treatment for a variety of mood and anxiety disorders. Thus, effective delivery of CBT can greatly relieve the mental health burden in resource-limited communities. However, there is insufficient emphasis on quality assurance for CBT. Decreases in CBT quality can significantly reduce the intended symptom improvement. It is important to monitor treatment quality and make sure the treatment is delivered as intended. Some research suggests that many providers do not implement CBT with fidelity. In fact, assessing fidelity on large scale has been a major challenge in implementation science.
Existing ways to test fidelity–rating recordings of therapy sessions–are time-consuming and labor-intensive, thus even less practical in resource-constricted communities. This project aims to score fidelity using CBT worksheets to test fidelity in a short and effective manner. On the whole project level, the additional use of routine clinical materials, which poses little additional burden to providers, can make large-scale quality monitoring feasible in resource-limited communities, thus enhancing the ongoing continuous quality improvement in clinics and leading to improved symptom outcomes.
For me, as a research assistant, it is motivating and exciting to think about why my work matters and how my small efforts can make a contribution to the whole process. I am currently working on data storing and tracking, which are tiny steps of the early stage of this project. However, properly conducting these small steps ensures the validity of the data used in later stages of the project and the smooth process of the project. The goals always sound promising and encouraging, but there are countless small steps building up to the final goal. There will also be countless research assistants, like me, devoting their efforts to these countless small steps. I feel grateful to be a small part of the whole process, and feel motivated to make my tiny contribution to the success of the project.
-Bingyu Xu ’19