Table 1.
Description of the fourteen cluster themes impacting CBSST implementation on ACT teams
| Cluster name | Cluster definition | Example statements included in cluster |
|---|---|---|
| 1. CBSST Fit with ACT Structure | The extent to which CBSST is appropriate to implement within the organizational requirements of ACT teams. | Disruptions to consistent visits with ACT clients (e.g., hospitalizations) |
| Providing CBSST in settings with distractions (e.g., public places) | ||
| Nature of ACT visits (e.g., going to doctor appts.) can inhibit provision of CBSST | ||
| 2. CBSST Fit with ACT Process | The extent to which CBSST is appropriate to implement with required procedures for ACT teams. | Frequency/intensity of other required, non-CBSST related service delivery changes |
| ACT provider’s ability to apply CBSST flexibly/“on the fly” during regular visits | ||
| Having sufficient time in ACT visits to go as “deep” as needed for CBSST | ||
| 3. Provider Perceptions about CBSST | ACT providers’ beliefs about CBSST. | Provider beliefs about whether CBSST improves client outcomes |
| Provider perception of usefulness/relevance of CBSST skills to other interventions | ||
| Perceived burden of delivering CBSST | ||
| 4. Staff Pressures/Other Demands | Existing requirements/ burdens on ACT teams that affect CBSST implementation. | Understaffed/overworked ACT teams |
| Additional administrative demands (e.g., documentation) needed to deliver CBSST | ||
| Impact on provider productivity requirements | ||
| 5. CBSST & ACT Synergy | The extent to which CBSST complements and improves ACT process and structure. | Flexibility to adapt CBSST while maintaining fidelity |
| CBSST structure/content makes ACT visits feel more purposeful | ||
| Creation of shared expectations for both ACT clients and providers | ||
| 6. Client Characteristics | Elements related to the ACT clients that are perceived to impact CBSST implementation. | Relevance of CBSST concepts/ideas to ACT clients |
| Openness of ACT clients to structured material (e.g., workbooks, homework) | ||
| ACT client motivation/buy-in to do CBSST | ||
| 7. Benefits of CBSST | Direct or indirect experience with positive outcomes attributed to CBSST. | Ability of CBSST to empower/increase self-esteem of ACT clients |
| Receiving positive feedback from ACT clients about CBSST | ||
| ACT client progress setting/accomplishing goals due to CBSST | ||
| 8. Coordination/ Interaction among ACT Providers | Managing the team-based approach of ACT to provide CBSST. | ACT providers having tools to track/monitor client progress through CBSST sessions |
| Seeing other ACT providers’ success delivering CBSST | ||
| Effectiveness of systems/processes to communicate client CBSST information among ACT providers | ||
| 9. Gov./Regulatory Factors | External rules, guidelines and resources that can be used to support CBSST implementation. | Data systems to measure and report meaningful CBSST outcomes |
| Available funding to deliver CBSST | ||
| Recognition of CBSST by government/public sector as an effective treatment approach | ||
| 10. Integration of CBSST into ACT | The extent to which CBSST can be successfully implemented with ACT requirements. | Compatibility of CBSST with other contractually mandated EBPs |
| Funding source willingness to adjust requirements (productivity, case-load, time-frames) | ||
| Staff CBSST “champion” to encourage use of CBSST | ||
| 11. Training Support | Initial and ongoing training support for and monitoring of CBSST implementation. | Substantial time allotted for practice and feedback during training/supervision for ACT providers |
| Having someone with organizational power monitor implementation of CBSST | ||
| Providing incentives for ACT provider use of CBSST | ||
| 12. Training Resources | Materials and tools available to ACT teams to support CBSST implementation. | Access to CBSST information/trainings (e.g., online materials) |
| Availability of on-going training opportunities for ACT providers | ||
| ACT provider access to an “on-call” CBSST trainer for emerging questions | ||
| 13. Multi-Level Agency Leadership | The impact of multiple levels of leadership on CBSST implementation within ACT teams. | Prioritization level of CBSST by agency |
| Communication about CBSST importance from ACT team supervisors/leads | ||
| Agency leadership buy-in of/support for CBSST | ||
| 14. Provider Characteristics | Elements related to ACT providers impacting CBSST implementation. | Provider openness to try new things |
| Provider confidence delivering CBSST | ||
| The level of ACT provider “buy-in” or enthusiasm for CBSST |