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Clinical Round Tables

Dissemination and Implementation Science

Clinical Round Table 13 - Culturally Enhanced CBT: Current Limitations of the CTRS

Saturday, June 27, 2026
11:00 AM - 12:30 PM PDT
Location: Yerba Buena Salon 14, B3 Level
Earn 1.5 Credit
Keywords: Education and Training, Culturally Responsible Programming, Psychometrics
Level of Familiarity: Moderate
Recommended Readings: Goldberg, S. B., Baldwin, S. A., Merced, K., Caperton, D. D., Imel, Z. E., Atkins, D. C., & Creed, T. (2020). The structure of competence: Evaluating the factor structure of the Cognitive Therapy Rating Scale. Behavior Therapy, 51(1), 113-122,   Muse, K., & McManus, F. (2013). A systematic review of methods for assessing competence in cognitive–behavioural therapy. Clinical Psychology Review, 33(3), 484-499,   Waltman, S. H., Sokol, L., & Beck, A. T. (2017). Cognitive behavior therapy treatment fidelity in clinical trials: review of recommendations. Current Psychiatry Reviews, 13(4), 311-315,   ,  
As CBT has been disseminated globally to diverse settings and populations, there have been enrichments and enhancements to the therapeutic modality to be culturally adaptive.

The Los Angeles County Department of Mental Health enlisted the services of the Academy of CBT from 2014- 2025 to train mental health clinicians to basic competency in CBT in one of the largest and most culturally diverse counties in the United States. Culturally responsive treatment is of keen interest to the clinicians, clients, and other stakeholders. Various culturally informed models and techniques have been developed, but questions remain about how stakeholders can assess the clinical competency and fidelity of CBT interventions when it is adapted to meet the needs of diverse populations.

The Cognitive Therapy Rating Scale (CTRS; Young and Beck, 1980) was developed decades ago and has become the gold standard for measuring treatment integrity of CBT; however, it was originally designed without any specific items to assess cultural responsiveness and cultural humility. The training program leadership therefore empowered the Diversity Action Committee of the Academy of CBT to develop and include a test item on Diversity awareness to be added to the CTRS. The item was developed to measure themes related to Cultural Knowledge, Humility, and Attunement.

This Diversity test item was added as a 12th item on the CTRS and piloted for about 5 years (from 2019-2024). The results of the preliminary data from this pilot study has over 2200 responses, and demonstrates a statistically significant positive correlation with the overall CTRS score and the Item 3 Understanding rating.

While this preliminary data is promising, there is room for improvement. As this is the cutting edge of competency based assessment for culturally enhanced CBT, the discussion will be opened up to include Roundtable attendees. There will be an egalitarian and solution focused discussion to help shape the next steps in the field of culturally competent clinician training and assessment.

Learning Objectives:

  • Operationalize cultural competency from the perspective of the CTRS Diversity research item
  • Consider how knowledge, skills, and attitudes related to culturally competent delivery of CBT can be evaluated and assessed using the CTRS.
  • Describe at least one advantage and one disadvantage to this methodology, and elaborate on future directions.