International dissemination

Dissemination of effective treatment is a major challenge in mental health care, and even though a clinic might offer evidence-based treatment, there is not a guarantee that patients who can access it will actually receive high-quality care.

International dissemination

The demand for the B4DT is immense from clinics from all over the world. Our hallmark is high-quality dissemination, meaning that the patients should be confident that when they are receiving the B4DT, they receive the same product as the one we developed. On behalf of the patients, we are not willing to do any compromises as goes for quality. Unlike pharmacological treatment which can be expected to work as long as the patient is willing to take the pill, this is not necessarily the case with psychological treatment, and before we initiate large scale international dissemination, we need to document that it transport across cultures.

This is a resource-demanding approach, and is only possible due to generous donations from the Kavli Trust, the Peace of Mind Foundation, and Michael Jenike.

The goal is to establish national training sites in each new culture, and to overcome language barriers, new teams will first be trained in Houston in English or Spanish and when certified, they will be invited to join the B4DT research network.

 
Bergen: The epicentre spreading the B4DT to the world.
The international dissemination of the B4DT is one of the two missions for the Bergen Center for Brain Plasticity. During a five-year period, staring in 2019, the goal is to establish B4DT on all continents.  With the Bergen site as the epicentre, this will systematically be achieved by first establishing an international training site in Houston, Texas, and if the results obtained compare to what can be expected, teams from both from the US as well as from other continents, will be trained in Houston. The US head of the Houston training site is Professor Thröstur Björgvinsson, McLean Hospital/ Harvard Medical School.

Currently approximately 35 B4DT teams in Norway are either certified to offer the B4DT, or are currently being trained. Iceland has already completed a pilot  thanks to the Kavli Trust,  and pending upon joint financing from the Icelandic health authorities they will hopefully be able to start B4DT groups soon, both for adults as well as for children/ adolescents.

A team at the Anxiety unit at Karolinska Sjukhuset, is currently being trained, and are expected to enrol patients during the spring 2019. The plan is to make the anxiety unit the B4DT training site in Sweden.

The B4DT: The hallmark of high quality treatment
Dissemination of effective treatment is a major challenge in mental health care.
The Bergen group has developed a model for dissemination that ensures that the effectiveness of the B4DT is maintained and that the patients are offered the same high quality B4DT wherever they are receiving the treatment.

The key features are the following:
1.    The B4DT therapists have to be trained by hands-on supervision and model learning
2.    Each therapist and the group leader needs to be certified based on their competency
3.    The B4DT has to be delivered in accordance to protocol
4.    The outcomes have to be routinely assessed by an independent expert
5.    The outcomes needs to be comparable to the already established norms

Only clinics who fulfil all five criteria can call themselves a B4DT clinic. Thus the B4DT is the hallmark of high quality treatment that works.

Only large scale dissemination if it works!
Even though hands-on training, certification, adherence to protocol and independent assessment of treatment-outcome together constitute the cornerstones of our dissemination strategy, we still do not know whether the B4DT will work in a novel cultural setting. This means that when the B4DT is disseminated, we carefully will follow this strategy: The Norwegian B4DT experts will first train a B4DT team and then do a pilot study together with them. If the results are not inferior to what can be expected based on standard evidence-based treatments for OCD, the new team will be invited to be part of the international B4DT dissemination project, which means to first systematically investigate if the results are comparable to what can be expected based on the established B4DT norms. If they are, a large-scaled dissemination can be initiated.

What does this dissemination strategy means for the patients?
The care for the patients is the one and only reason for the dissemination strategy we have chosen. The World Health Organization has ranked OCD among the 10 worst disorders, including medical conditions. Due to the outstanding results, The B4DT has received tremendous attention, and patients from all over the world contact us in hope for a better future for themselves or their loved ones.

The B4DT is a practical, evidence-based, focused and deliberate exposure based treatment. It builds on four decades of empirical research and theories about the most effective approach to OCD treatment. The innovation and strength of the work is how it combines the most effective elements of proven treatment into one of the most profound, rapid, and robust treatment approaches that we have seen in recent years.

We, who have created the B4DT know better than any-one else that it is not easy to achieve the kind of change we have documented. And we know that it does not take much to ruin the approach. 

This implies the following: Only clinics who already are delivering high quality care for the disorder in question will be admitted to the training program. This implies that patients will be offered high-quality care from the very beginning delivered by the local team in close collaboration with the B4DT experts. When the local team is certified to offers the B4DT, the patients will be asked to participate in a trial where they have to agree to either be enrolled to the B4DT directly, or wait for four weeks. Everything else will be similar to the way standard B4DT is delivered. When it starts, the trial will be approved by the  Norwegian ethical research board (IRB) as well as the local IRB's.
 
The international sites.
Houston OCD program In Houston, Texas, the Peace of Mind Foundation (https://peaceofmind.com) and Dr. Michael Jenike have pledged their support to sponsor the cost of the two pilot studies in the USA that will be conducted at the Houston OCD Program (https://houstonocdprogram.org).  This will be done in collaboration with the Kavli Trust . The team overseeing this dissemination are Drs. Kvale, Hansen and Björgvinsson in collaboration with McLean Hospital, which will -- among other things -- provide the ethical research approval (IRB).  Training of the Houston team will start spring 2019.

Iceland  Kvíðameðferðarstöðin (KMS), Reykjavik, Island are already certified for treatment of adults, and a pilot study has been performed - with comparable results. They are now awaiting some partly funding from the Icelandic Health Authorities in order to be able to initiate the controlled trial.

Sweden Karolinska Sjukhuset, the anxiety unit, Stockholm is one of the Sweden's foremost institutions in treatment of OCD.  A B4DT team has been trained in Bergen, and the pilot groups will be initiated second quarter of 2019. 

 
How to enrol as a B4DT team?
The goal is to establish national training sites in each new culture, and to overcome language barriers, new teams will first be trained in Houston (in English or Spanish) and when certified, they will be invited to join the B4DT research network.

The Board of BCBP will bi-annually admit new clinics for training. Clinics who wants to be considered, are asked to submit an application, and we will contact you. More information will follow. 

 
What does the training consist of?

The core features  of our model for dissemination are hands-on training and certification of therapist/group leaders. combined with an integrated quality- and outcome assessment that allows for benchmarking. It is now possible to establish "an expected outcome" where over 90% the patients reliably improve after the 4 days. If the treatment outcomes with a particular team fail to deliver optimal results, this elicits hands-on supervision and re-certification of the team and/or clinic. This integrated assessment is an essential part of the B4DT, and is an ongoing requirement for any clinic or team that wants to deliver the B4DT.


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