Despite the mounting evidence of the benefits of cognitive therapy for depression and suicidal behaviors over usual care, like other evidence-based psychosocial treatments (EBTs), it has not been widely adopted in clinical practice. Studies have shown that training followed by intensive consultation is needed to prepare providers to an appropriate level of competency in complex, multisession treatment packages such as cognitive therapy. Given the critical role of training in EBT implementation, more information on factors associated with the success and challenges of training programs is needed. To identify potential reasons for variation in training outcomes across ten agencies in a large, urban community mental health system, we explored program evaluation data and examined provider, consultant, and training program administrator perspectives through follow-up interviews. Perceptions of cognitive therapy, contextual factors, and reactions to feedback on audio recordings emerged as broad categories of themes identified from interviews. These factors may interact and impact clinician efforts to learn cognitive therapy and deliver it skillfully in their practice. The findings highlight experiences and stakeholder perspectives that may contribute to more or less successful training outcomes. 1. Introduction The public health impact and high rates of depression and suicide in community populations are well established [1–5]. Accumulating evidence indicates that providing psychosocial evidence-based treatments (EBTs) such as cognitive therapy (CT; [6]) results in substantial benefits to physical and mental health symptoms, quality of life outcomes, and reduction of health disparities and suicide attempts [7–9]. Training clinicians in community mental health agencies to provide CT for depression can result in improved treatment outcomes [8]. Like other EBTs, however, CT has not been widely adopted in clinical practice. Until recently, few systematic implementation efforts or training opportunities existed in the public sector [10, 11]. In response to the shortage of adequately trained providers [10], policymakers have devoted substantial resources in recent years to train providers in EBTs in the context of large-scale implementation programs [11, 12]. In 2007, the Beck Initiative was formed as a collaborative partnership between the Philadelphia Department of Behavioral Health and Intellectual disAbilities Services (DBHIDS), and the University of Pennsylvania (Penn) to implement CT within the city’s behavioral health provider agencies. The mental health
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