Table 2.

Description of Training Visits

Training visit	Training/meeting topic	Staff in attendance	Content	Number of sessions	Phase of diffusion
#1 March 2015	Administration Meeting Introduction to CBT General Competencies Train-the-Trainer Assertiveness Training NSSI and Acting Out Principles of Behaviorism Assessment and Documentation Progress Monitoring	CLM, RCC, PM All All TT, ST, CD All All All TH, CLM, CA TH, CLM, CA	Discussing reassessment outcomes Introducing staff to CBT Focused on general treatment competencies (e.g., relationship) Orienting administrative staff around the train-the-trainer model How to effectively be assertive with clients and colleagues Interacting with clients displaying NSSI and behavior disruptions Training on the foundations of behaviorism Informing staff about the importance of treatment assessment Training staff on how to integrate progress monitoring	14	Implementation
#2 August 2015	CBT Competencies Specific CBT Techniques Data Collection/Progress Monitoring Implementation Team Meetings	TH, CM All TH IT	Articulating core competencies of CBT Introducing specific CBT techniques (e.g., cognitive restructuring) Reintroducing progress monitoring Meeting to coordinate with implementation teams	14	Implementation
#3 March 2016	Problem-Solving Treatment Daily CBT Integration Progress Monitoring Follow-Up Core Beliefs and Behavioral Experiments Motivational Interviewing Putting CBT First Expert Cohort Session Implementation Teams	All All TH TH CT SM CT IT	Introduction to cognitive model problem-solving techniques Training on using CBT techniques throughout daily care Follow-up on the implementation of progress monitoring Training on techniques to address core beliefs (e.g., experiments) Teaching staff to integrate motivational interviewing into treatment Changing culture to prioritize CBT as a first-line approach Working with clinical staff to understand barriers to change Meeting with the implementation teams to reorient goals	8	Implementation
#4 November 2016	Train-the-Trainer, Part 1 CBT in Session Core Skills—Developing Competency Imagery Rehearsal CBT Sustainment Train-the-Trainer, Part 2	CC TH All TH IT CC	Orienting administrative staff around the train-the-trainer model Training therapists on effectively using CBT in therapy session Using CBT core skills competently Using evidence-based technique to reducing recurring nightmares Introducing methods for program sustainment Orienting administrative staff around the train-the-trainer model	8	Implementation
#5 March 2017	CBT Endorsement CBT Supervision CBT Endorsement Principles of Behaviorism How to Use Core CBT Skills in Your Role Integrating Core Skills in Session Case Conceptualization	CC CC CC, IT, PM/PS, TH All All CC, TH	Introducing the CBT endorsement process to CBT coaches Establishing CBT-oriented supervision sessions Introducing the CBT endorsement process to staff Refreshing the principles of behaviorism Showing all staff how to integrate CBT in their daily roles How to use CBT core skills in therapy sessions Practicing the application of cognitive conceptualization	7	Sustainment
#6 October 2017	Endorsement Process Implementation Team Meeting CBT and Family Therapy Using Level 1 CBT Skills Core Skills Refresher Point System Intake Checklist Core Skills Follow-Up	CC IT FT All All All TH, IT, FT FT, PS	Laying out the endorsement process to CBT coaches Meeting with the implementation teams regarding endorsement Integrating CBT techniques into family therapy Training on how to use core skills on oneself Training staff over core skills again, led by implementation team Introducing staff to the consequences of giving negative rewards Covering the intake checklist with clinical staff Reviewing core skills with family therapists	12	Sustainment
#7 July 2018	Sustainment Meeting Reinforcement System Implementation Teams Family Handbook/CBT Core Skills Bringing CBT to Family Therapy CTRS for Therapists Core Skills Refresh/Incident Reports Intake Checklist Client Skills Tracker CBT Coaches	AS PM, TH, CT IT FT, PS FT, PS TH AS TH, CM TH, CM, PM CC	Meeting with vice president covering sustainment needs Introducing the new reinforcement system Meeting covering sustainment tasks and team-building exercise Introducing the family therapy handbook/refresher on core skills Covering how to integrate core skills in family sessions Practice scoring therapy sessions for supervision Refresher on CBT core skills and using CBT in incident reports Covering how to use the intake checklist effectively Practicing use of the CBT skills tracker Exit meeting, sustainment follow-up, Q&A	14	Sustainment

Note. CBT = cognitive-behavioral therapy; NSSI = nonsuicidal self-injury; CTRS = cognitive Therapy Rating Scale; CLM = clinical manager; RCC = residential care coordinator; PM = program manager; All = all staff; TT = transformers team; ST = staff trainer; CD = clinical director; TH = therapist; CA = clinical assistant; CM = case manager; IT = implementation team; SM = site management; CT = clinical team; CC = CBT coach; PS = program supervisor; FT = family therapist; AS = administrative staff.