Interview with Clinical Leader Dr. Bruce Chorpita

Article from the Fall 2014 Issue of the Child and Family Chronicle, written by Jenna Paternostro

Bruce Chorpita is Professor of Psychology and Professor of Psychiatry and Biobehavioral Sciences at UCLA and President of PracticeWise, LLC. His work is aimed at improving the effectiveness of mental health service systems for children through innovation in treatment design, clinical decision-making and information, delivery models, and system architecture.

Dr. Bruce Chorpita Interview with Child and Family Chronicle of Palo Alto University

Recent work has focused on designing treatments that can adapt in real time to local contexts and to emergent youth and family needs, while staying grounded in scientifically tested procedures.  Other recent work has focused on how service systems can more easily and efficiently prepare a service array to address the needs of the community, and how to sustain effective practice through professional development activities, innovative supervision models, and performance feedback systems. This year, he is finishing a treatment study funded by the MacArthur Foundation for youth in Los Angeles County, which should further inform how effective practices can be widely, practically, and effectively applied in real world contexts.  

Dr. Bruce Chorpita agreed to a telephone interview in preparation for his upcoming workshop at Palo Alto University on March 7, 2015. Dr. Chorpita answered several questions relating to his current work on Modular CBT and dissemination.   In the following sections, I have paraphrased our conversation.

What led to the modular approach to psychotherapy?

Dr. Chorpita’s early clinical training with Drs. David Barlow, Ron Drabman, and Anne Marie Albano often involved approaches to care that were implicitly working across multiple strategies or manuals to deal with complexity. For the most challenging cases, it was common to select strategies or procedures from more  than one evidence-based manual to fit individual case presentations. Early in his career, Dr. Chorpita worked to formalize this process, outlining some of the early algorithms for  how to select and arrange practices that were part of many  successful treatments. Much of this work was an attempt to “reverse engineer” the expert decisions of his supervisors—mapping out the formula behind how they chose techniques for which cases, and from which sources. 

What benefits does a modular approach bring that traditional approaches do not?

Dr. Chorpita pointed out that in many industries outside of clinical practice- from furniture building to software development modular designs allow a faster innovation cycle and an increasing number of end products from a small number of initial elements. What this means for clinical research is that we can do very tightly controlled tests by changing only one module at a time, and we can accelerate dissemination because new modules can be plugged into existing frameworks without creating a new program, training, or workforce development initiative. For practice, this means that a small number of  strategies can be arranged in an enormous number of ways, so that personalized delivery of otherwise structured, evidence[ based procedures is possible. He was careful to point out that  people often conflate modularity with flexibility, but that in fact  modularity allows flexibility to be adjusted (e.g., from low to  high) with minimal changes to the protocol itself, other than editing a flowchart or logic model. This way, we can attempt to find the ideal level of flexibility, without writing many different protocols.

What do you believe to be the biggest challenge of disseminating programs to children and adolescents?

Dr. Chorpita reported that based on his research, even if a  clinician knows every single manual ever created, approximately 1/3 of children would still not qualify for EBT’s requirements, suggesting that clinicians cannot serve their entire population.  Thus, the collection of available manuals do not address the full scope of what most practitioners typically see in their offices. Dr. Chorpita further stated that the proliferation of EBTs can create user confusion, with clinicians having difficulty knowing which ones to choose. Therefore, he believes that the Xield needs to develop content management platforms, like iTunes or Pandora, that assist with finding, selecting, and arranging the “greatest  hits” of EBTs in easily digested units.

This Pandora station system for psychotherapy, is that what you hope to see with MAP (Mapping Evidence-Based Treatments for Children and Adolescents)?

 Dr. Chorpita compared the therapist’s role in treatment planning with MAP to someone learning to cook. At first, we may follow  many recipes and cookbooks, but eventually the “chef” begins to  abstract how dishes go together, and can even begin to  effectively manage when the unexpected occurs (a missing  ingredient, too much salt, a last-minute report of a food allergy among the guests). MAP is intended to provide these rules of how cooking works, so that one can “follow the recipe” in most cases, but can adjust them to preferences and on the fly if needed. In that sense, MAP is more like a kit of how to build a treatment than it is like a treatment itself. 

What are your hopes for the future of modular CBT with children and adolescents?

In the next 10 years, Dr. Chorpita hopes to go from proof of concept to an industrial revolution in behavioral health care, where there are collaborative systems that feature all the  greatest work from the field’s leading treatment developers, such  as Drs. Patterson, Kendall, and Ollendick, as well as research from the best labs in the country.  He aspires to create a new framework for collaboration among treatment developers and with providers that will represent a faster, more dynamic, and more effective way to connect scientific discovery with practice delivery. 

What adivice do you have for graduate students who are entering the field?

The advice that Dr. Chorpita tells his graduate students is that you are lucky enough that you get to attend graduate school, which is a rare and fortunate venture. He went on to say that although there are many pressures to succeed with publications, internship, etc., it is important not to lose sight of the desire to leave the world a better place than when you entered it. Dr. Chorpita concluded the interview by stating “Go out into the world, solve big problems, be a visionary, use your good fortune that got you into graduate school. You are a superhero – fight  crime and rid the world of evil!” 

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