Sleep / Wake Disorders
Determinants of community provider's assessment of the fit of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) to their clients and their context
Marlen Diaz, B.A. (she/her/hers)
Clinical Science Graduate Student
University of California, Berkeley
Ceres, California
Sophia M. Oliver, None
Research Assistant
University of California, Berkeley
Sacramento, California
Kiely Bol, None
Undergraduate Research Assistant
University of California, Berkeley
Danville, California
Allison G. Harvey, Ph.D.
Professor
University of California, Berkeley
BERKELEY, California
Background: Sleep and circadian problems are prominent transdiagnostic features of severe mental illness (SMI). For SMI clients who often have complex and comorbid sleep and circadian problems, transdiagnostic evidence-based psychological treatments (EBPTs), such as the Transdiagnostic Sleep and Circadian Intervention (TranS-C), have shown to be effective. EBPTs in community mental health centers (CMHCs) are scarce, training for providers is limited, and EBPTs are often not sustained after adoption. Scholars have noted that provider disengagement with EBPTs is influenced by perception of treatment fit. The goal of this research was to examine the impact on provider ratings of fit of three determinants: (1) the providers’ theoretical orientation, (2) the number of completed cases and, (3) years of clinical experience. The hypotheses tested were: providers with a cognitive behavioral orientation, providers who completed more TranS-C cases and more years of clinical experience will rate the fit of TranS-C to be higher at post treatment.
Method: Providers (N= 136, average age = 41 , 79% female, 44% White) across CMHCs in ten counties in California participated in a Standard or Adapted TranS-C training, as part of a NIMH-funded study. CMHCs are major, publicly funded providers of treatment for SMI. Theoretical orientation and years of clinical experience was collected at pre-treatment. After the training and again after completing a client case, providers assessed TranS-C fit via the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Delivery of TranS-C was assessed via the number of completed client cases.
Results: Providers with a background in cognitive behavioral therapy perceived the fit of TranS-C to be greater at post-treatment after controlling for pre-treatment ratings (β = 2.29, 95% CI [0.65, 3.93], p = .006). Providers with a higher number of completed cases also perceived the fit of TranS-C to be greater at post treatment, after controlling for pre-treatment ratings (β = 0.15, 95% CI [-0.00, 0.30], p = .05). There was no effect of years of clinical experience.
Conclusions: These findings suggest that providers with cognitive behavioral theoretical orientation and those with a higher number of completed cases are more likely to perceive greater TranS-C fit. By understanding which characteristics influence perception of treatment, we gain valuable insight into who might benefit most from training efforts and how perceptions of treatments influence delivery of treatment.
