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Cho E, Lyon AR, Tugendrajch SK, Marriott BR, Hawley KM. Assessing provider perceptions of training: Initial evaluation of the Acceptability, Feasibility, and Appropriateness Scale. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221086269. [PMID: 37091090 PMCID: PMC9924265 DOI: 10.1177/26334895221086269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a well-documented gap between research and practice in the treatment of mental health problems. One promising approach to bridging this gap is training community-based providers in evidence-based practices (EBPs). However, a paucity of valid, reliable measures to assess a range of outcomes of such trainings impedes our ability to evaluate and improve training toward this end. The current study examined the factor structure of the Acceptability, Feasibility, Appropriateness Scale (AFAS), a provider-report measure that assesses three perceptual implementation outcomes of trainings that may be leading indicators of training success (i.e., acceptability, feasibility, and appropriateness). Providers who attended half-day EBP trainings for common mental health problems reported on the acceptability, feasibility, and appropriateness of these trainings using the AFAS ( N = 298). Confirmatory factor analysis indicates good fit to the hypothesized three-factor structure (RMSEA = .058, CFI = .990, TLI = .987). Acceptability, feasibility, and appropriateness were three distinct but related constructs. Cronbach's alpha ranged from .86 to .91, indicating acceptable internal consistency for the three subscales. Acceptability and feasibility, but not appropriateness, scores varied between workshops, though variability across workshops was generally limited. This initial evaluation of the AFAS is in line with recent efforts to enhance psychometric reporting practices for implementation outcome measures and provides future directions for further development and refinement of the AFAS. Plain Language Summary Clinician training in evidence-based practices is often used to increase implementation of evidence-based practices in mental health service settings. However, one barrier to evaluating the success of clinician trainings is the lack of measures that reliably and accurately assess clinician training outcomes. This study was the initial evaluation of the Acceptability, Feasibility, Appropriateness Scale (AFAS), a measure that assesses the immediate outcomes of clinician trainings. This study found some evidence supporting the AFAS reliability and its three subscales. With additional item refinement and psychometric testing, the AFAS could become a useful measure of a training's immediate impact on providers.
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Affiliation(s)
- Evelyn Cho
- University of Missouri, Columbia, MO, USA
| | - Aaron R. Lyon
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Brookman-Frazee L, Chlebowski C, Villodas M, Garland A, McPherson J, Koenig Y, Roesch S. The effectiveness of training community mental health therapists in an evidence-based intervention for ASD: Findings from a hybrid effectiveness-implementation trial in outpatient and school-based mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:678-689. [PMID: 34983251 PMCID: PMC10987077 DOI: 10.1177/13623613211067844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Publicly funded mental health services play an important role in caring for school-age children with autism spectrum disorder (ASD); however, therapists report a lack of specialized ASD training, which families identity as a barrier in obtaining mental health services for their children. An Individualized Mental Health Intervention for ASD (AIM HI) was developed in collaboration with community stakeholders to respond to identified needs of children and community therapists. The current study examined the effects of therapist training in AIM HI on the changes in therapist practice, including therapists' use of evidence-based intervention strategies in session. Data were collected from a study conducted in community outpatient and school based mental health programs randomly assigned to receive AIM HI therapist training or observation of routine care. Therapist and child clients were enrolled from participating programs. Therapists in AIM HI training received training and consultation for 6 months while delivering the AIM HI intervention to a participating client; therapists in usual care delivered routine care. Both groups of therapists video recorded psychotherapy sessions which were scored by trained raters. Differences between training groups were examined using multilevel modeling. Therapists trained in AIM HI were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more effective pursuit of caregiver and children skill teaching. Therapist licensure moderated some training outcomes.
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Affiliation(s)
| | | | | | | | | | - Yael Koenig
- San Diego County Behavioral Health Services, USA
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Vroom EB, Massey OT, Akbari Z, Bristol SC, Cook B, Green AL, Levin BL, Tyson DM, Johnson ME. Exploring perceptions of implementation practice capacity in community-based behavioral health organizations. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1700-1716. [PMID: 34797922 PMCID: PMC8917074 DOI: 10.1002/jcop.22749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs' ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). Results revealed participants rated IPAs on the importance scale higher than IPAs on the present scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.
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Affiliation(s)
- Enya B Vroom
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Oliver T Massey
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zahra Akbari
- Department of Economics, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Skye C Bristol
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Brandi Cook
- Department of Chemistry, Cell Biology, Microbiology, and Molecular Biology, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Amy L Green
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Bruce L Levin
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Dinorah M Tyson
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Micah E Johnson
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
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Therapist Self-Report of Fidelity to Core Elements of Family Therapy for Adolescent Behavior Problems: Psychometrics of a Pragmatic Quality Indicator Tool. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:298-311. [PMID: 34476623 PMCID: PMC8854349 DOI: 10.1007/s10488-021-01164-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
Therapist-report measures of evidence-based interventions have enormous potential utility as quality indicators in routine care; yet, few such tools have shown strong psychometric properties. This study describes reliability and validity characteristics of a therapist-report measure of family therapy techniques for treating adolescent conduct and substance use problems: Inventory of Therapy Techniques for Core Elements of Family Therapy (ITT-CEFT). Study participants included 31 staff therapists treating 68 adolescent clients in eight community-based mental health and substance use clinics. Therapists submitted ITT-CEFT checklists and companion audio recordings for 189 sessions. The ITT-CEFT contains 13 techniques identified as core elements of three manualized family therapy models that are empirically supported for the target group. Therapists also reported on their use of three motivational interventions, and independent observers coded the submitted recordings. ITT-CEFT factor validity was shown via confirmatory factor analyses of the tool's theoretical structure. Derived modules were: Family Engagement (four items; Cronbach's α = .72); Relational Orientation (five items; α = .74); and Interactional Change (four items; α = .66). Concurrent validity analyses showed fair-to-excellent therapist reliability compared to observer ratings (ICCs range .64-.75); they showed moderate therapist accuracy compared to observer mean scores, reflecting a tendency to overestimate delivery of the techniques. Discriminant validity analyses showed tool differentiation from motivational interventions. Results offer provisional evidence for the feasibility of using the therapist-report ITT-CEFT to anchor quality procedures for family therapy interventions in real-world settings.Trial Registration: The parent clinical trial is registered at www.ClinicalTrials.gov , ID: NCT03342872 (registration date: 11.10.17).
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Becker-Haimes EM, Wislocki K, DiDonato S, Jensen-Doss A. Predictors of Clinician-Reported Self-Efficacy in Treating Trauma-Exposed Youth. J Trauma Stress 2022; 35:109-119. [PMID: 34048094 PMCID: PMC10676627 DOI: 10.1002/jts.22688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022]
Abstract
Clinicians' self-efficacy with regard to delivering evidence-based interventions (EBIs) to youth is an important target for both improving EBI use in the community and mitigating the risk of clinician burnout and turnover. Examining predictors of clinician self-efficacy to treat trauma-exposed youth is, therefore, an important step for informing the design of implementation strategies to enhance the mental health workforce's capacity to deliver EBIs in this population. We examined predictors of clinician self-efficacy in working with trauma-exposed youth in a sample of practicing mental health clinicians (N = 258, M age = 34.4 years, 85.0% female). Clinicians were recruited and surveyed as part of a larger study examining how clients' exposure to potentially traumatic events influences clinician decision-making. Results of regression models indicated that training in any trauma treatment model, being trained via a variety of formats (e.g., in-person training, online, supervision), and training in a variety of treatment models were all associated with higher perceived self-efficacy regarding effectively treating trauma-exposed youth. Of the treatment models and training formats examined, receiving in-person training, R2 = .10, and training in trauma-focused cognitive behavioral therapy, R2 = .10, were the strongest predictors of higher self-efficacy ratings. Clinician discipline, R2 = .04, and clinical practice factors, R2 = .20, were also related to self-efficacy. Collectively, the R2 indicated a large effect, with the predictors explaining 25.4% of the variance in self-efficacy ratings. Implications for designing implementation strategies targeting clinician self-efficacy and future research are discussed.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
- Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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Wilkerson AK, Wardle-Pinkston S, Dietch JR, Pruiksma KE, Simmons RO, Bunnell BE, Taylor DJ. Web-based provider training of cognitive behavioral therapy of insomnia: engagement rates, knowledge acquisition, and provider acceptability. Cogn Behav Ther 2022; 51:343-352. [PMID: 35099360 DOI: 10.1080/16506073.2021.1996453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Insomnia is common but severely underreported and undertreated. One possible reason for this problem is the lack of providers in cognitive behavioral therapy for insomnia (CBT-I). To address this we created CBTIweb.org, an online training platform for providers to learn the basics of sleep, assessing insomnia, and CBT-I. The present study assessed the reach of CBTIweb by examining engagement, knowledge acquisition, and perceived acceptability. Participants who registered for CBTIweb self-reported their practice setting and personal characteristics (i.e. degree, profession, licensure status). Knowledge acquisition was assessed with pre- and post-tests, and provider acceptability was assessed via a survey. In the first three months after launching CBTIweb, 2586 providers registered and 624 of these completed the training within three months of registering. Chi-square tests of independence revealed no differences in completion rates by education or profession, though trainees were more likely to initiate and complete treatment than licensed providers. Paired t tests revealed significant knowledge acquisition, and most providers positively rated the website navigation, content, aesthetics, and understanding of core CBT-I skills. This study demonstrated CBTIweb is an effective platform for training health professionals to be minimally proficient in the gold standard treatment for insomnia disorder.
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Affiliation(s)
- Allison K Wilkerson
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Sophie Wardle-Pinkston
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Richard Oliver Simmons
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Brian E Bunnell
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, FL, USA
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychology, University of Arizona, Tucson, AZ, USA
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Frank HE, Milgram L, Freeman JB, Benito KG. Expanding the reach of evidence-based mental health interventions to private practice: Qualitative assessment using a policy ecology framework. FRONTIERS IN HEALTH SERVICES 2022; 2:892294. [PMID: 36925863 PMCID: PMC10012822 DOI: 10.3389/frhs.2022.892294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
Background Evidence-based interventions (EBIs) for mental health disorders are underutilized in routine clinical practice. Exposure therapy for anxiety disorders is one particularly difficult-to-implement EBI that has robust empirical support. Previous research has examined EBI implementation determinants in publicly funded mental health settings, but few studies have examined EBI implementation determinants in private practice settings. Private practice clinicians likely face unique barriers to implementation, including setting-specific contextual barriers to EBI use. The policy ecology framework considers broad systemic determinants, including organizational, regulatory, social, and political contexts, which are likely relevant to EBI implementation in private practice settings but have not been examined in prior research. Methods Qualitative interviews were conducted to assess private practice clinicians' perceptions of EBI implementation determinants using the policy ecology framework. Clinicians were asked about implementing mental health EBIs broadly and exposure therapy specifically. Mixed methods analyses compared responses from clinicians working in solo vs. group private practice and clinicians who reported high vs. low organizational support for exposure therapy. Results Responses highlight several barriers and facilitators to EBI implementation in private practice. Examples include determinants related to organizational support (e.g., colleagues using EBIs), payer restrictions (e.g., lack of reimbursement for longer sessions), fiscal incentives (e.g., payment for attending training), and consumer demand for EBIs. There were notable differences in barriers faced by clinicians who work in group private practices compared to those working in solo practices. Solo private practice clinicians described ways in which their practice setting limits their degree of colleague support (e.g., for consultation or exposure therapy planning), while also allowing for flexibility (e.g., in their schedules and practice location) that may not be available to clinicians in group practice. Conclusions Using the policy ecology framework provides a broad understanding of contextual factors that impact private practice clinicians' use of EBIs, including exposure therapy. Findings point to potential implementation strategies that may address barriers that are unique to clinicians working in private practice.
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Affiliation(s)
- Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Lauren Milgram
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Jennifer B Freeman
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
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Schleider JL, Beidas RS. Harnessing the Single-Session Intervention approach to promote scalable implementation of evidence-based practices in healthcare. FRONTIERS IN HEALTH SERVICES 2022; 2:997406. [PMID: 36925822 PMCID: PMC10012621 DOI: 10.3389/frhs.2022.997406] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
Effective implementation of evidence-based practices often involves multi-level strategies targeting individual-, organizational-, and system-level determinants of change. Although these multi-level implementation approaches can successfully facilitate EBP uptake, they tend to be complex and resource intensive. Accordingly, there is a need for theory-driven, generalizable approaches that can enhance efficiency, cost-effectiveness, and scalability of existing implementation approaches. We propose the Single-Session Intervention approach as an unexplored path to developing low-cost and scalable implementation strategies, especially those targeting individual-level behavior change. We argue that single-session strategies (S3) for implementation, which can simultaneously target myriad barriers to individual behavior change, may promote clinicians' EBP uptake and sustainment in a manner that is low-resource and scalable. We first overview the evidence-base supporting the Single-Session Intervention approach for patient-level outcomes; situate this approach within the implementation science literature by outlining its intersections with a leading framework, the Theoretical Domains Framework (TDF), as an exemplar; and illustrate how the TDF might directly inform the design and evaluation of single-session strategies for EBP implementation. Overall, single-session strategies (S3) for implementation reflect a promising but yet-to-be-tested means of streamlining and scaling individual-level behavior change efforts in healthcare settings. Future partnered research is needed to gauge the potential of this approach across diverse clinical and community contexts.
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Affiliation(s)
- Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Rinad S Beidas
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
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Woodard GS, Triplett NS, Frank HE, Harrison JP, Robinson S, Dorsey S. The impact of implementation climate on community mental health clinicians’ attitudes toward exposure: An evaluation of the effects of training and consultation. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 36210960 PMCID: PMC9536473 DOI: 10.1177/26334895211057883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Most evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) and anxiety disorders include exposure; however, in community settings, the implementation of exposure lags behind other EBT components. Clinician-level determinants have been consistently implicated as barriers to exposure implementation, but few organizational determinants have been studied. The current study examines an organization-level determinant, implementation climate, and clinician-level determinants, clinician demographic and background factors, as predictors of attitudes toward exposure and changes in attitudes following training. Method: Clinicians (n = 197) completed a 3-day training with 6 months of twice-monthly consultation. Clinicians were trained in cognitive behavioral therapy (CBT) for anxiety, depression, behavior problems, and trauma-focused CBT (TF-CBT). Demographic and background information, implementation climate, and attitudes toward exposure were assessed in a pre-training survey; attitudes were reassessed at post-consultation. Implementation climate was measured at the aggregated/group-level and clinician-level. Results: Attitudes toward exposure significantly improved from pre-training to post-consultation (t(193) = 9.9, p < .001; d = 0.71). Clinician-level implementation climate scores did not predict more positive attitudes at pre-training (p > .05) but did predict more positive attitudes at post-consultation (ß = −2.46; p < .05) and greater changes in those attitudes (ß = 2.28; p < .05). Group-level implementation climate scores did not predict attitudes at pre-training, post-consultation, or changes in attitudes (all ps > .05). Higher frequency of self-reported CBT use was associated with more positive attitudes at pre-training (ß = −0.81; p < .05), but no other clinician demographic or background determinants were associated with attitudes at post-consultation (all p > .05) or with changes in attitudes (all p > .05). Conclusions: Clinician perceptions of implementation climate predicted greater improvement of attitudes toward exposure following EBT training and consultation. Findings suggest that organizational determinants outside of training impact changes in clinicians’ attitudes. Training in four EBTs, only two of which include exposure as a component, resulted in positive changes in clinicians’ attitudes toward exposure, which suggests non-specialty trainings can be effective at changing attitudes, which may enable scale-up. Exposure is highly effective for treating trauma symptoms and anxiety-based disorders, but it is not commonly used in community mental health settings. Clinicians who endorsed higher expectations, support, and rewards for using exposure in their agency had more positive attitudes toward exposure after training and consultation. Additionally, clinicians who endorsed that exposure is expected, supported, and rewarded in their agency showed a greater improvement in attitudes throughout the training process. Organizational culture can affect clinicians’ attitude changes in the training process, and therefore should become a focus of training efforts.
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Affiliation(s)
- Grace S. Woodard
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Noah S. Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Julie P. Harrison
- Department of Psychiatry, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Sophia Robinson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Woodfield MJ, Cargo T, Merry SN, Hetrick SE. Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13116. [PMID: 34948725 PMCID: PMC8700887 DOI: 10.3390/ijerph182413116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Parent-Child Interaction Therapy (PCIT) is an effective parent training approach for a commonly occurring and disabling condition, namely conduct problems in young children. Yet, despite ongoing efforts to train clinicians in PCIT, the intervention is not widely available in New Zealand and Australia. METHODS We undertook a cross-sectional online survey of clinicians in New Zealand and Australia who had completed at least the 40-h initial PCIT training, to understand the barriers they encountered in their implementation efforts, and the extent to which attitudes toward time-out influenced implementation. The overall response rate was 47.5% (NZ: 60%; Australia: 31.4%). RESULTS Responses suggested that participants generally viewed PCIT as both acceptable and effective. Australian participants reported seeing significantly more clients for PCIT per week than those in NZ (Medians 0 and 2, respectively; χ2(1) = 14.08, p < 0.001) and tended to view PCIT as more effective in treating disruptive and oppositional behaviour (95% CI: -0.70, -0.13, p = 0.005). Participants currently seeing PCIT clients described it as more enjoyable to implement than those not using PCIT (95% CI: -0.85, -0.10, p = 0.01). Thirty-eight percent of participants indicated that they adapt or tailor the standardised protocol, primarily by adding in content relating to emotion regulation, and removing content relating to time-out. Participants generally felt that they had fewer skills, less knowledge, and less confidence relating to the Parent-Directed Interaction phase of PCIT (which involves time-out), compared with the Child-Directed Interaction phase. CONCLUSION While we had hypothesised that time-out represented an intra-intervention component that detracted from implementation success, results suggested that clinician concern over the use of time-out was present but not prominent. Rather, the lack of access to suitable equipment (i.e., one-way mirror and ear-piece) and difficulties associated with clients attending clinic-based sessions were barriers most commonly reported by clinicians. We suggest that future research might consider whether and how PCIT might be "re-implemented" by already-trained clinicians, moving beyond simply training more clinicians in the approach.
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Affiliation(s)
- Melanie J. Woodfield
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
- Auckland District Health Board, Auckland 1023, New Zealand
| | - Tania Cargo
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
- Department of Psychology, University of Auckland, Auckland 1023, New Zealand
| | - Sally N. Merry
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
| | - Sarah E. Hetrick
- The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland 1023, New Zealand; (T.C.); (S.N.M.); (S.E.H.)
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC 3010, Australia
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61
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Forman DP, Moyers TB. Should Substance Use Counselors Choose a Direction For Their Clients? Motivational Interviewing Trainers May Be Ambivalent. ALCOHOLISM TREATMENT QUARTERLY 2021; 39:446-454. [PMID: 34658499 DOI: 10.1080/07347324.2020.1858732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Motivational Interviewing (MI) is comprised of a client-centered relationship and a clear intention on the part of the practitioner to influence behavior change. This study explores MI trainers' decisions about their use of directionality in MI as they instruct others in the method. 111 MI trainers were asked to select content they would include in a hypothetical MI training. Almost half of trainers chose to teach trainees to "always maintain an attitude of equipoise", a strategy that is contradicted by MI theory and empirical data. This finding suggests a theoretical rift within the MI community with implications for substance use counseling.
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Affiliation(s)
- David P Forman
- University of New Mexico, Department of Psychology, Center for Alcoholism, Substance Abuse, and Addictions
| | - Theresa B Moyers
- University of New Mexico, Department of Psychology, Center for Alcoholism, Substance Abuse, and Addictions
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Bond S, Binet É, Pudelko B. L’utilisation des technologies pour optimiser la formation des intervenants en santé mentale aux traitements fondés sur les données probantes : où en sommes-nous ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081510ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La formation massive d’intervenants en santé mentale figure parmi les moyens proposés pour améliorer l’accès aux traitements fondés sur les données probantes pour divers troubles mentaux courants. Si les technologies de communication et de diffusion des connaissances (visioconférence, plateformes Web) peuvent aider à rendre la formation plus accessible dans le temps et dans l’espace, il est nécessaire de bien évaluer leur apport au développement des compétences chez les intervenants.
Objectifs Établir comment les technologies sont utilisées pour optimiser la formation des intervenants et quels sont les effets des formations en ligne sur l’acquisition des connaissances et habiletés cliniques.
Méthode Une revue rapide de la littérature a été réalisée. Pour être incluses, les études devaient concerner une formation en ligne destinée aux intervenants en pratique clinique active, porter sur le traitement d’un trouble mental courant ou d’une toxicomanie et comporter une mesure objective des connaissances ou des habiletés cliniques. Les études ont été analysées et comparées en fonction des méthodes et activités d’apprentissage intégrant les technologies numériques.
Résultats Vingt études ont été recensées. Les méthodes d’apprentissage passives, impliquant peu ou pas d’interactivité, prédominent dans les formations en ligne en mode asynchrone (FLA), alors que les activités permettant un niveau élevé d’interaction avec le formateur, comme les jeux de rôle ou la supervision, se retrouvent dans les formations en mode synchrone. Acquisition des connaissances : les FLA semblent efficaces pour améliorer les connaissances des intervenants sur une période d’au moins 6 mois. La formation en salle ou l’ajout d’une activité de supervision ne produisent pas de résultats d’apprentissage supérieurs à la FLA. Acquisition des habiletés : aucune conclusion ne peut être tirée quant aux effets des formations en ligne, asynchrones, synchrones ou mixtes, car les résultats sont partagés, voire contradictoires.
Conclusion En considérant la faible qualité méthodologique des études analysées qui limite la nature et la portée des conclusions de la présente recension, les résultats des études permettent d’avancer que les FLA qui comportent des technologies interactives de base, telles que des quiz en ligne, peuvent constituer un moyen simple et efficace pour améliorer les connaissances des intervenants en santé mentale.
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Affiliation(s)
- Suzie Bond
- Ph. D., psychologue, Professeure régulière, Département Sciences humaines, lettres et communication, Université TÉLUQ, Chercheuse associée, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | | | - Béatrice Pudelko
- Ph. D., psychologie cognitive, Chercheuse régulière, Groupe de recherche interdisciplinaire sur la cognition et le raisonnement professionnel (GIRCoPro), Université de Montréal, Professeure agrégée, Département Éducation, Université TÉLUQ
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McGuier EA, Rothenberger SD, Friedman A, Kolko DJ. An equivalence analysis of provider education in youth mental health care. Health Serv Res 2021; 56:440-452. [PMID: 33844276 PMCID: PMC8143690 DOI: 10.1111/1475-6773.13659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence-based treatment. DATA SOURCE Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) in a major metropolitan area in the United States. STUDY DESIGN We tested for equivalence between providers (N = 182) with and without advanced degrees in treatment-related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer-rated competence in AF-CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes. DATA COLLECTION Providers completed measures prior to randomization and at 6-month follow-up, after completion of training and consultation in AF-CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months. PRINCIPAL FINDINGS Providers without advanced degrees were largely non-inferior to those with advanced degrees in treatment-related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non-inferior to providers with advanced degrees in consultation attendance (B = -1.42; confidence interval (CI) = -3.01-0.16; margin of equivalence (Δ) = 2), number of case presentations (B = 0.64; CI = -0.49-1.76; Δ = 2), total training hours (B = -4.57; CI = -10.52-1.37; Δ = 3), and trainer-rated competence in AF-CBT (B = -0.04; CI = -3.04-2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10-0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive. CONCLUSIONS Provider-level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence-based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence-based treatments.
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Affiliation(s)
- Elizabeth A. McGuier
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Scott D. Rothenberger
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Abbey Friedman
- Western Psychiatric HospitalUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - David J. Kolko
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Western Psychiatric HospitalUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
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Kimber M, Harms S, Soreni N, Inrig M, Acai A, Lipman EL, Sassi R, Streiner DL, MacMillan HL. LIVES for families psychological first aid training programme to address COVID-19 psychological distress: a mixed methods acceptability and feasibility protocol. BMJ Open 2021; 11:e049995. [PMID: 33952558 PMCID: PMC8102861 DOI: 10.1136/bmjopen-2021-049995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Best practice approaches for addressing COVID-19-related psychological distress among young people (<25 years) and their families remain unclear. Psychological first aid (PFA) is promoted by public health authorities to provide psychological support in the context of extreme events; however, there is limited evidence for its effectiveness. As a prerequisite to conducting a randomised controlled trial to examine programme effectiveness, this project is evaluating the acceptability and feasibility of implementing and evaluating a PFA training programme ('LIVES for Families') for mental health (MH) practitioners to improve their ability to recognise and respond to COVID-19-related psychological distress among their clients. METHODS AND ANALYSIS We are using a triangulation mixed methods research design; complementary strands of quantitative and qualitative data are being collected in parallel and will be merged at the interpretation phase of the project. The quantitative strand uses a repeated measures design; a consecutive sample of MH practitioners (n=80) providing MH support to young people or their families are being recruited to participate in the LIVES for Families PFA training programme and complete quantitative measures at baseline (pretraining), 2-week and 6-month follow-up time points. The qualitative strand uses fundamental description and semistructured interviews with a subset of practitioners (n=30), as well as managers of MH agencies (n=20). A mixed methods joint display and associated narrative will generate a comprehensive understanding regarding acceptability and feasibility. ETHICS AND DISSEMINATION The Hamilton Integrated Research Ethics Board approved the study (project number: 11295). Results will be shared broadly with the policy and practice community through publications, presentations and public webinars. As a brief, evidence-informed intervention, the LIVES for Families PFA training programme is suitable in its mode of delivery across care settings. The outcomes of this study could have international implications for mitigating the MH impacts of viral pandemics.
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Affiliation(s)
- Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Harms
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Noam Soreni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
| | - Maggie Inrig
- Lynwood Charlton Centre, Hamilton, Ontario, Canada
| | - Anita Acai
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ellen Louise Lipman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
| | - Roberto Sassi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Inoue M, Irino T, Furuyama N, Hanada R. Observational and Accelerometer Analysis of Head Movement Patterns in Psychotherapeutic Dialogue. SENSORS (BASEL, SWITZERLAND) 2021; 21:3162. [PMID: 34063286 PMCID: PMC8124818 DOI: 10.3390/s21093162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/10/2021] [Accepted: 04/28/2021] [Indexed: 12/30/2022]
Abstract
Psychotherapists, who use their communicative skills to assist people, review their dialogue practices and improve their skills from their experiences. However, technology has not been fully exploited for this purpose. In this study, we analyze the use of head movements during actual psychotherapeutic dialogues between two participants-therapist and client-using video recordings and head-mounted accelerometers. Accelerometers have been utilized in the mental health domain but not for analyzing mental health related communications. We examined the relationship between the state of the interaction and temporally varying head nod and movement patterns in psychological counseling sessions. Head nods were manually annotated and the head movements were measured using accelerometers. Head nod counts were analyzed based on annotations taken from video data. We conducted cross-correlation analysis of the head movements of the two participants using the accelerometer data. The results of two case studies suggest that upward and downward head nod count patterns may reflect stage transitions in counseling dialogues and that peaks of head movement synchrony may be related to emphasis in the interaction.
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Affiliation(s)
- Masashi Inoue
- Department of Information and Communication Engineering, Tohoku Institute of Technology, 35-1 Yagiyama Kasumicho, Taihaku-ku, Sendai 982-8577, Japan
| | - Toshio Irino
- Faculty of Systems Engineering, Wakayama University, Sakaedani 930, Wakayama City 640-8510, Japan;
| | - Nobuhiro Furuyama
- Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Saitama, Tokorozawa City 359-1192, Japan;
| | - Ryoko Hanada
- Department of Psychology, Tokyo Woman’s Christian University, 2-6-1 Zempukuji, Suginami-ku, Tokyo 167-8585, Japan;
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Polnay A, McIntosh LG, Burnett A, Williams A, Cahill C, Wilkinson P, Mohammad F, Patrick J. Examining the factor structure, reliability, and validity of the main outcome measure used in mentalization-based therapy skills training. Health Sci Rep 2021; 4:e245. [PMID: 33614982 PMCID: PMC7883382 DOI: 10.1002/hsr2.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIMS Multiple national guidelines stress the importance for clinicians to possess good therapeutic skills for working with patients with significant relational difficulties (who may receive a diagnosis of personality disorder). Training clinicians in mentalization-based treatment skills (MBT-S) is one approach to address this. The main outcome measure used in MBT-S studies is the Knowledge and Application of MBT Questionnaire (KAMQ). However, an absence of research into the properties and validity of the KAMQ has limited the methodological quality of MBT-S evaluations so far. The aim of this study was therefore to investigate the factor structure, internal consistency, reliability, and validity of the KAMQ. METHODS Using an existing multiprofessional sample of 217 clinicians from 2014 to 2016, we undertook exploratory factor analysis to determine the factor structure and internal consistency of the KAMQ. Convergent validity of the measure with the Attitudes to Personality Disorder Questionnaire (APDQ) was assessed in a subset of this dataset where both questionnaires had been administered (n = 92). Additionally, by recruiting a new sample of 70 clinicians, we assessed the measure's test-retest reliability. RESULTS Factor analysis found three factors underlying 17 of the 20 KAMQ items, relating to therapeutic skills in mentalizing, beliefs about applying MBT in practice, and specific MBT knowledge. The KAMQ was revised following the factor analysis to form the KAMQ-2 with 17 items. Internal consistency (α = .85, 95% confidence interval [CI] = 0.80-0.89) and test-retest reliability (ICC = 0.84, 95% CI = 0.73-0.91) were good. In correlation analyses, the KAMQ-2 showed convergent validity with the main factor from the APDQ (n = 48; r s = 0.39, P < .01). CONCLUSION The KAMQ-2 provides a short, reliable self-report instrument which probes clinicians' knowledge about mentalizing skills, and beliefs about using these. There was preliminary evidence for validity. The properties of the KAMQ-2 mean that more robust evaluation and development of MBT-S is now possible.
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Affiliation(s)
- Adam Polnay
- Medical DivisionThe State HospitalCarstairsUK
- Psychotherapy DepartmentRoyal Edinburgh HospitalEdinburghUK
- Division of PsychiatryRoyal Edinburgh Hospital, University of EdinburghEdinburghUK
| | - Lindsey G. McIntosh
- Division of PsychiatryRoyal Edinburgh Hospital, University of EdinburghEdinburghUK
- Psychological Therapy ServiceThe State HospitalCarstairsUK
| | - Aileen Burnett
- Psychological Therapy ServiceThe State HospitalCarstairsUK
| | - Andrea Williams
- Personality Disorder and Homelessness TeamGlasgow City Health and Social Care PartnershipGlasgowUK
| | | | | | | | - Jon Patrick
- Medical DivisionThe State HospitalCarstairsUK
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Brogan L, McPhee J, Gale-Bentz E, Rudd B, Goldstein N. Shifting probation culture and advancing juvenile probation reform through a community-based, participatory action research-informed training. BEHAVIORAL SCIENCES & THE LAW 2021; 39:6-25. [PMID: 33666287 DOI: 10.1002/bsl.2497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Many jurisdictions are currently transforming their juvenile probation systems to reflect research-informed, developmentally based case management approaches. Training, developed through a community-based, participatory action research (CBPAR) framework and guided by a community-academic partnership, may promote probation staff's readiness for such change. This paper examined whether such training could serve as an effective method to impact organizational culture by exploring shifts in probation staff's knowledge, attitudes, and beliefs about graduated response - a structured juvenile probation case management system that aligns with research on adolescent development and youth behavior change. Data came from 559 juvenile probation staff trained in graduated response theory and practice between 2016 and 2019. Results demonstrated that at the end of a 1-day, CBPAR-grounded training program, participating staff reported significantly more buy-in to graduated response, greater knowledge of this new system, and attitudes more strongly in favor of graduated response and intended behaviors. Study findings revealed important shifts indicative of readiness for change within juvenile probation departments. Additional implementation strategies are needed to extend training gains and overcome organizational- and system-level barriers to change.
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Affiliation(s)
- Leah Brogan
- Stoneleigh Foundation, Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jeanne McPhee
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Brittany Rudd
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Naomi Goldstein
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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Creed TA, Crane ME, Calloway A, Olino TM, Kendall PC, Stirman SW. Changes in Community Clinicians' Attitudes and Competence following a Transdiagnostic Cognitive Behavioral Therapy Training. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34541540 PMCID: PMC8444627 DOI: 10.1177/26334895211030220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Although the literature suggest that attitudes toward evidence-based practices (EBPs) are associated with provider use of EBPs, less is known about the association between attitudes and how competently EBPs are delivered. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training. Methods Program evaluation data was collected during implementation of an EBP in a large community mental health network. Clinicians (N=891) received intensive training in cognitive behavioral therapy followed by six months of consultation. Attitudes were assessed using the Evidence-Based Practice Attitude Scale, and competence was assessed using the Cognitive Therapy Rating Scale. Data were analyzed by fitting three latent change score models to examine the relationship between changes in attitudes and competence across the training and within its two phases (workshop phase, consultation phase). Results Latent change models identified significant improvement in attitudes (Ms latent change≥1.03, SEs≤ 0.18, zs≥6.55, ps< .001) and competence (Ms latent change ≥14.16, SEs≤3.10, zs≥2.82, ps<.001) across the full training and in each phase. Higher pre-workshop attitudes predicted significantly greater change in competence in the workshop and across training (bs≥1.62, SEs≤0.90, z≥1.09, p<.04, β≥0.10); however, contrary to our hypothesis, post-workshop attitudes did not significantly predict change in competence in consultation (b=1.62, SE=0.86, z=1.87, p=.06, β=0.09). Change in attitudes and change in competence in the training period and within the two phases were not significantly correlated. Conclusions Results indicate that pre-training attitudes about EBPs present a target for implementation interventions, given their relation to changes in both attitudes and competence throughout training. Following participation in in itial training workshops, other factors such as subjective norms, implementation culture, or system-level policy shifts may be more predictive of change in competence through consultation.
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Affiliation(s)
- Torrey A Creed
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 3046, Philadelphia, PA, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Amber Calloway
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 3046, Philadelphia, PA, USA
| | - Thomas M Olino
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Road NC-PTSD, Menlo Park, CA, 94025, USA
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Assessing and promoting the use of implementation intentions in clinical practice. Soc Sci Med 2020; 265:113490. [DOI: 10.1016/j.socscimed.2020.113490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
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Beck AK, Baker AL, Carter G, Wratten C, Bauer J, Wolfenden L, McCarter K, Britton B. Assessing Adherence, Competence and Differentiation in a Stepped-Wedge Randomised Clinical Trial of a Complex Behaviour Change Intervention. Nutrients 2020; 12:E2332. [PMID: 32759848 PMCID: PMC7469004 DOI: 10.3390/nu12082332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A key challenge in behavioural medicine is developing interventions that can be delivered adequately (i.e., with fidelity) within real-world consultations. Accordingly, clinical trials should (but tend not to) report what is actually delivered (adherence), how well (competence) and the distinction between intervention and comparator conditions (differentiation). PURPOSE To address this important clinical and research priority, we apply best practice guidelines to evaluate fidelity within a real-world, stepped-wedge evaluation of "EAT: Eating As Treatment", a new dietitian delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS Dietitians (n = 18) from five Australian hospitals delivered a period of routine care and following a randomly determined order each site received training and began delivering the EAT Intervention. A 20% random stratified sample of audio-recorded consultations (control n = 196; intervention n = 194) was coded by trained, independent, raters using a study specific checklist and the Behaviour Change Counselling Inventory. Intervention adherence and competence were examined relative to apriori benchmarks. Differentiation was examined by comparing control and intervention sessions (adherence, competence, non-specific factors, and dose), via multiple linear regression, logistic regression, or mixed-models. RESULTS Achievement of adherence benchmarks varied. The majority of sessions attained competence. Post-training consultations were clearly distinct from routine care regarding motivational and behavioural, but not generic, skills. CONCLUSIONS Although what level of fidelity is "good enough" remains an important research question, findings support the real-world feasibility of integrating EAT into dietetic consultations with HNC patients and provide a foundation for interpreting treatment effects.
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Affiliation(s)
- Alison Kate Beck
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Chris Wratten
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Judith Bauer
- Centre for Dietetics Research, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kristen McCarter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ben Britton
- Hunter New England Health, New Lambton 2305, Australia
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Leffler JM, D'Angelo EJ. Implementing Evidence-Based Treatments for Youth in Acute and Intensive Treatment Settings. J Cogn Psychother 2020; 34:185-199. [PMID: 32817401 DOI: 10.1891/jcpsy-d-20-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence-based treatments (EBTs) have been well studied in outpatient and research settings to address a myriad of mental health concerns. Research studies have found benefits and challenges when implementing these interventions. However, less is known about the implementation of EBTs in acute and intensive treatment settings such as inpatient psychiatric hospitalization (IPH) units, partial hospitalization programs (PHPs), or intensive outpatient programs (IOPs). As a result, the specific benefits and challenges of providing EBTs in these settings are less clear. For example, challenges of implementing EBTs in IPHs, PHPs, and IOPs can include working within a multi-disciplinary team setting and sustaining trained staff. The current article provides an overview of implementing EBTs in IPHs PHPs, and IOPs. Current PHP, IOP, and IPH models of implementing evidence-based interventions along with strategies for engaging stakeholders, program development and implementation, and measurement are reviewed. Further considerations for sustainability and practice consideration are also provided.
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Affiliation(s)
| | - Eugene J D'Angelo
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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