Open Access Open Badges Research

Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety

Julie M Edmunds1*, Kendra L Read2, Vanesa A Ringle3, Douglas M Brodman2, Philip C Kendall2 and Rinad S Beidas4

Author Affiliations

1 Center for Effective Child Therapy, Judge Baker Children’s Center, 53 Parker Hill Avenue, Boston 02120, MA, USA

2 Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia 19122, PA, USA

3 New York University Child Study Center, 1 Park Avenue, 7th floor, New York 10016, NY, USA

4 Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia 19104, PA, USA

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Implementation Science 2014, 9:89  doi:10.1186/s13012-014-0089-9

Published: 17 July 2014



Questions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety.


Of the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes.


Findings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes.


Sustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation.

Sustainment; Evidence-based practice; Training; Consultation; Knowledge; Attitudes; Implementation; Penetration