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Thaler L, Paquin-Hodge C, Leloup AG, Wallace A, Oliverio S, Freiwald S, Israel M, Steiger H. Barriers and Facilitators to the Implementation of an Eating Disorders Knowledge Exchange Program for Non-specialist Professionals. J Behav Health Serv Res 2022; 50:365-380. [PMID: 36180648 PMCID: PMC9524729 DOI: 10.1007/s11414-022-09822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
Despite availability of evidence-based treatments for eating disorders (EDs), individuals with EDs often do not receive informed treatment. Training of non-specialized clinicians by experienced professionals through knowledge exchange (KE) programs is an effective way to enhance accessibility to evidence-based treatments for EDs. The authors conducted a qualitative analysis of factors that facilitated or impeded the uptake of an ED-focused KE program. Semi-structured interviews were conducted with mental health professionals (n = 43) and managers (n = 11) at 13 community mental-health sites at which the KE program was offered. Data were analyzed using a qualitative content analysis. Key facilitators identified were management support for the program and building competence through ongoing supervision of clinicians. Main barriers were limited access to ED patients to treat and having insufficient time to apply ED interventions in front-line settings. The results provide insights into the practical imperatives involved in implementing a KE initiative for ED treatment.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada. .,Psychiatry Department, McGill University, Montreal, QC, Canada.
| | - Chloé Paquin-Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | | | - Aimée Wallace
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Stephanie Oliverio
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, QC, Canada
| | - Shiri Freiwald
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada.,Department of Psychology, McGill University, Montreal, QC, Canada
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2
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Balán IC, Lentz C, Giguere R, Dolezal C, Kajura-Manyindo C, Kutner BA, Zalwango A, Makoni R, Madlala B, Makala Y, Khanyile N, Kadyamusuma M, Kachenjera L, Ndhlovu-Forde Z, Tuswa-Haynes N. Inconsistent Counselor Fidelity in Delivering an Evidence-Based Adherence Intervention During a PrEP Trial. AIDS Behav 2022; 26:698-708. [PMID: 34390433 PMCID: PMC8840968 DOI: 10.1007/s10461-021-03429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Evidence-based adherence counseling interventions must be delivered with fidelity to ensure that their effectiveness is retained, but little is known regarding how counselors in biomedical HIV trials deliver these interventions. Forty-two counselors from the MTN-025/HOPE Study, which was conducted in 14 sites in sub-Saharan Africa, participated. They completed a quantitative assessment and consented for their HOPE counseling session ratings to be analyzed. Twenty-two (52%) self-identified as research nurses and 20 (48%) as counselors. Of 928 session ratings, 609 (66%) were classified as Good, 188 (20%) as Fair, and 131 (14%) as Poor, based on pre-established criteria. Overall mean ratings for session tasks and global components (each rated from 1 to 5) were 4.12 (SD = 0.45; range 2.46-4.73) and 4.02 (SD = 0.64; range 1.75-4.79), respectively. Twenty-six (62%) counselors attained Good or Fair ratings on at least 85% of their sessions, but 33% of counselors had more than 25% of their sessions rated as Poor; three counselors (7%) never met criteria for a Good session. Even after extensive training, counselors' fidelity to the intervention varied. Our findings highlight the value of fidelity monitoring using session audio-recordings, the importance of ongoing coaching and support, and the need to plan for counselors with consistently poor fidelity.
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Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
- Florida State University College of Medicine, Tallahassee, FL, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Aisha Zalwango
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Rujeko Makoni
- University of Zimbabwe College of Health Sciences Zengeza Clinical Trials Unit, Harare, Zimbabwe
| | - Bernadette Madlala
- CAPRISA Clinical Trials Unit for AIDS/Tuberculosis Prevention and Treatment, Durban, South Africa
| | - Yvonne Makala
- University of North Carolina Lilongwe Clinical Research Site, Lilongwe, Malawi
| | - Nombuso Khanyile
- South African Medical Research Council Tongaat Clinical Trials Unit, Durban, South Africa
| | - McLoddy Kadyamusuma
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Lonely Kachenjera
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Zanele Ndhlovu-Forde
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - NoCamagu Tuswa-Haynes
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
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3
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Couturier J, Kimber M, Barwick M, Woodford T, Mcvey G, Findlay S, Webb C, Niccols A, Lock J. Family-based treatment for children and adolescents with eating disorders: a mixed-methods evaluation of a blended evidence-based implementation approach. Transl Behav Med 2021; 11:64-73. [PMID: 31747024 DOI: 10.1093/tbm/ibz160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this study, we evaluated a blended implementation approach with teams learning to provide family-based treatment (FBT) to adolescents with eating disorders. Four sites participated in a sequential mixed method pre-post study to evaluate the implementation of FBT in their clinical settings. The implementation approach included: (a) preparatory site visits; (b) the establishment of implementation teams; (c) a training workshop; (d) monthly clinical consultation; (e) monthly implementation consultation; and (f) fidelity assessment. Quantitative measures examining attitudes toward evidence-based practice, organizational learning environment and organizational readiness for change, as well as, individual readiness for change were delivered pre- and postimplementation. Correlational analyses were used to examine associations between baseline variables and therapist fidelity to FBT. Fundamental qualitative description guided the sampling and data collection for the qualitative interviews performed at the conclusion of the study. Seventeen individuals participated in this study (nine therapists, four medical practitioners, and four administrators). The predetermined threshold of implementation success of 80% fidelity in every FBT session was achieved by only one therapist. However, mean fidelity scores were similar to those reported in other studies. Participant attitudes, readiness, and self-efficacy were not associated with fidelity and did not change significantly from pre- to postimplementation. In qualitative interviews, all participants reported that the implementation intervention was helpful in adopting FBT. Our blended implementation approach was well received by participants. A larger trial is needed to determine which implementation factors predict FBT fidelity and impact patient outcomes.
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Affiliation(s)
| | | | - Melanie Barwick
- University of Toronto, ON, Canada.,Research Institute, Hospital for Sick Children, Toronto, ON, Canada
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Thaler L, Freiwald S, Paquin Hodge C, Fletcher É, Cottier D, Kahan E, Rossi E, Piat M, Lal S, Israel M, Steiger H. A Tertiary-Care/Primary-Care Partnership Aimed at Improving Care for People with Eating Disorders. Community Ment Health J 2018; 54:1154-1161. [PMID: 29948625 DOI: 10.1007/s10597-018-0290-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
We describe the implementation and impact of a province-wide program of knowledge exchange (KE), aimed at developing capacity for the treatment of people with eating disorders (EDs). The program is designed to equip clinicians working in nonspecialized health-care installations with skills to evaluate and treat people with EDs. Trainings were conducted at 21 institutions. The majority of clinicians reported satisfaction with the KE program and indicated that the trainings enhanced their confidence and ability to treat patients with EDs. A subset of clinicians received case supervision with a specialist ED therapist and followed patients with EDs (n = 119). Treated patients showed significant improvements on eating and depressive symptoms, and reported satisfaction with the treatments they received.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada. .,Psychiatry Department, McGill University, Montreal, QC, Canada. .,Eating Disorders Continuum, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Shiri Freiwald
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Chloe Paquin Hodge
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | - Émilie Fletcher
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Danaelle Cottier
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Erika Rossi
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychology Department, Université du Québec à Montréal, Montreal, QC, Canada
| | - Myra Piat
- Psychiatry Department, McGill University, Montreal, QC, Canada.,Douglas Institute Clinical Activities, Knowledge Transfer and Teaching Directorate, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,School of Social Work, McGill University, Montreal, QC, Canada
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,PEPP-Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada.,Psychology Department, McGill University, Montreal, QC, Canada
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5
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Macneil C, Foster F, Nicoll A, Osman H, Monfries R, Cotton S. Evaluation of a professional development training programme for mental health clinicians specializing in early psychosis. Early Interv Psychiatry 2018; 12:483-490. [PMID: 28744970 DOI: 10.1111/eip.12424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/30/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
The Early Psychosis Prevention and Intervention Centre Statewide Services (ESW) team provides training for multidisciplinary clinicians that specialise in early psychosis across the State of Victoria, Australia. The aim of this paper is to describe the 4-phase approach utilised by ESW to prepare for and deliver workshops, to report on participants' ratings of the ESW workshops, and to make recommendations for other trainers of early psychosis clinicians. Between March 2009 and September 2014, ESW provided 85 training workshops that had a strong focus on evidence-based approaches and international guidelines, and utilized clinical examples of early psychosis interventions. At the conclusion of each workshop, participants were asked to complete a questionnaire that comprised qualitative and quantitative elements. These assessed perceived trainer knowledge, learning, interactivity and specific topic feedback. The focus of this paper will be on describing the quantitative data resulting from these questionnaires. A total of 1708 clinicians provided feedback on the 85 workshops. There was a high level of compliance, with 83.0% of workshop participants completing the questionnaires. Feedback was positive across all areas, with the 2 areas that were most highly endorsed being that presenters "appeared to know their subject matter well" (endorsed by 98.4% of participants) and that "topics were explained well" (endorsed by 96.8% of participants). Training for early psychosis clinicians that focusses on core clinical topics, is well planned, incorporates feedback from previous training, and is based on adult learning principles, is likely to be effective and well received by early psychosis clinicians.
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Affiliation(s)
- Craig Macneil
- EPPIC Statewide Services, Orygen Youth Health, Melbourne, Victoria, Australia.,Early Psychosis Prevention & Intervention Centre (EPPIC), Orygen Youth Health, Melbourne, Victoria, Australia
| | - Frances Foster
- EPPIC Statewide Services, Orygen Youth Health, Melbourne, Victoria, Australia
| | - Amanda Nicoll
- EPPIC Statewide Services, Orygen Youth Health, Melbourne, Victoria, Australia
| | - Helen Osman
- EPPIC Statewide Services, Orygen Youth Health, Melbourne, Victoria, Australia
| | - Richard Monfries
- EPPIC Statewide Services, Orygen Youth Health, Melbourne, Victoria, Australia
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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6
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Couturier J, Lock J, Kimber M, McVey G, Barwick M, Niccols A, Webb C, Findlay S, Woodford T. Themes arising in clinical consultation for therapists implementing family-based treatment for adolescents with anorexia nervosa: a qualitative study. J Eat Disord 2017; 5:28. [PMID: 28878927 PMCID: PMC5582386 DOI: 10.1186/s40337-017-0161-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/08/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Our study aims to explore and describe themes arising in sessions of clinical consultation with therapists implementing Family-Based Treatment (FBT) for adolescents with Anorexia Nervosa (AN). There is currently no literature describing the content of clinical consultation for FBT. Thus, this knowledge will add to the evidence-base on what therapists need from consultants in ongoing clinical consultation. METHODS Eight therapists at four sites participated in this study, which spanned a two-year period. Following a two-day training workshop, each therapist treated at least one adolescent patient presenting with a restrictive eating disorder with FBT, focusing on adherence to the treatment manual. Clinical consultation sessions occurred monthly and were led by an external FBT expert. Thirty-five (average per site = 9) audio recorded group clinical consultation sessions were transcribed verbatim and coded for themes. Twenty percent of the transcripts were double-coded to ensure consistency. Fundamental qualitative description guided the sampling and data collection. RESULTS Thematic content analysis revealed ten common themes relating to the provision of clinical consultation to therapists implementing FBT in clinical practice: encouraging parental meal time supervision,discussing the role of mothers, how to align parents, ensuring parental buy-in, when to transition to Phase 2, weighing the patient and the patients' knowledge of their weight, the role of siblings in FBT sessions, how best to manage patient co-morbidities, the role of the father in FBT and how best to manage the family meal. CONCLUSIONS In conclusion, clinical consultation themes aligned with many of the central tenets of FBT, including how to help parents align their supportive approach during the refeeding process, and how to help parents assume control of eating disordered behaviours. This knowledge helps to guide consultants to anticipate common issues brought forward by therapists attempting to implement FBT.
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Affiliation(s)
- J Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St. West, Hamilton, ON L8N3Z5 Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - J Lock
- Department of Psychiatry & Neurosciences, Stanford University, Stanford, USA
| | - M Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St. West, Hamilton, ON L8N3Z5 Canada.,Offord Centre, McMaster University, Hamilton, Canada
| | - G McVey
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - M Barwick
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - A Niccols
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St. West, Hamilton, ON L8N3Z5 Canada.,Offord Centre, McMaster University, Hamilton, Canada
| | - C Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St. West, Hamilton, ON L8N3Z5 Canada
| | - S Findlay
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - T Woodford
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St. West, Hamilton, ON L8N3Z5 Canada
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7
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Affiliation(s)
- Jonathan M Mond
- a Department of Psychology , Macquarie University , Sydney , New South Wales , Australia.,b Research School of Psychology , The Australian National University , Canberra , Australian Capital Territory , Australia.,c School of Medicine , Western Sydney University , Campbelltown , New South Wales , Australia
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8
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Couturier J, Kimber M, Lock J, Barwick M, McVey G, Findlay S, Webb C, Boettcher M, Niccols A, Woodford T. Implementing highly specialized and evidence-based pediatric eating disorder treatment: protocol for a mixed methods evaluation. Implement Sci 2015; 10:40. [PMID: 25888744 PMCID: PMC4381401 DOI: 10.1186/s13012-015-0231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Eating disorders, which include anorexia nervosa and bulimia nervosa, are common in adolescent females and can have serious emotional and physical consequences, including death. Despite our knowledge about the severity of these illnesses, previous research indicates that adolescent patients are not receiving the best available treatment with fidelity. The main goal of this project is to reduce the knowledge gap between what research indicates is the best known treatment and what is actually delivered in clinical practice. Informed by the National Implementation Research Network model and the Consolidated Framework for Implementation Research meta-theory, our primary study aim is to increase the capacity of Ontario-based therapists to provide family-based treatment, by providing training and ongoing supervision. Methods/design We will use a multi-site case study with a mixed method pre/post design to examine several implementation outcomes across four eating disorder treatment programs. We will provide a training workshop on family-based treatment as well as ongoing monthly supervision. In addition, we will assemble implementation teams at each site and coach them by phone on a monthly basis regarding any process issues. Our main outcomes include fidelity to the treatment model using quantitative evaluation of audio-recorded therapy sessions, as well as qualitative analysis of the perceptions of the implementation process using audio-recorded focus groups with all clinicians and administrators involved in the study. Discussion To our knowledge, this is the first study to evaluate an implementation strategy for an evidence-based treatment for eating disorders. Challenges to date include obtaining ethics approval at all sites, and recruitment. This research will help to inform future studies on how to best implement evidence-based treatments in this field.
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Affiliation(s)
| | - Melissa Kimber
- McMaster University, 1200 Main St. W, Hamilton, Ontario, Canada.
| | - James Lock
- Stanford University, 401 Quarry Road, Stanford, California, USA.
| | - Melanie Barwick
- Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada.
| | - Gail McVey
- Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada.
| | - Sheri Findlay
- McMaster University, 1200 Main St. W, Hamilton, Ontario, Canada.
| | - Cheryl Webb
- McMaster University, 1200 Main St. W, Hamilton, Ontario, Canada.
| | | | - Alison Niccols
- McMaster University, 1200 Main St. W, Hamilton, Ontario, Canada.
| | - Tracy Woodford
- McMaster University, 1200 Main St. W, Hamilton, Ontario, Canada.
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9
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Piat M, Pearson A, Sabetti J, Steiger H, Israel M, Lal S. International training programs on eating disorders for professionals, caregivers, and the general public: A scoping review. J Eat Disord 2015; 3:28. [PMID: 26279836 PMCID: PMC4536892 DOI: 10.1186/s40337-015-0066-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022] Open
Abstract
This review identified and synthesized published training programs on eating disorders (ED) (anorexia nervosa or bulimia nervosa) for professionals, natural supporters of people with ED, or the public. A scoping review using the Arksey and O'Malley (2005) framework was conducted. Four data bases were searched, for all years, and manual searches from three additional sources were also conducted. Experts on ED were consulted for validation of the identified studies. A narrative synthesis was performed. A total of 20 evaluation studies from five countries were identified, and reviewed in relation to 14 ED training programs. Characteristics of the training programs, and study characteristics, were highly diverse, as shown on Table 1 which compiles results from the charted data. Evaluations were equally divided between training for healthcare and education professionals (9), and training for families or other carers of people with ED (10). One study evaluated ED training for the general public. We found that training orientation varies with the interests and needs of different trainee groups. While most studies assessed trainee outcomes, future research needs to give greater consideration to patient perspectives, and to the relationship between training and evaluation approaches, improved knowledge, and better care.
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Affiliation(s)
- Myra Piat
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Montreal, Québec, H4H 1R3 Canada
| | - Alexis Pearson
- Douglas Mental Health University Institute, Montreal, Canada
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, Canada
| | - Howard Steiger
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Montreal, Québec, H4H 1R3 Canada
| | - Mimi Israel
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Montreal, Québec, H4H 1R3 Canada
| | - Shalini Lal
- École de Réadaptation, Université de Montréal, Montréal, Canada
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10
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Kimber M, Couturier J, Jack S, Niccols A, Van Blyderveen S, McVey G. Decision-making processes for the uptake and implementation of family-based therapy by eating disorder treatment teams: a qualitative study. Int J Eat Disord 2014; 47:32-9. [PMID: 24065690 DOI: 10.1002/eat.22185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/04/2013] [Accepted: 08/05/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore the decision-making processes involved in the uptake and implementation of evidence-based treatments (EBTs), namely, family-based treatment (FBT), among therapists and their administrators within publically funded eating disorder treatment programs in Ontario, Canada. METHOD Fundamental qualitative description guided sampling, data collection, and analytic decisions. Forty therapists and 11 administrators belonging to a network of clinicians treating eating disorders completed an in-depth interview regarding the decision-making processes involved in EBT uptake and implementation within their organizations. Content analysis and the constant comparative technique were used to analyze interview transcripts, with 20% of the data independently double-coded by a second coder. RESULTS Therapists and their administrators identified the importance of an inclusive change culture in evidence-based practice (EBP) decision-making. Each group indicated reluctance to make EBP decisions in isolation from the other. Additionally, participants identified seven stages of decision-making involved in EBT adoption, beginning with exposure to the EBT model and ending with evaluating the impact of the EBT on patient outcomes. Support for a stage-based decision-making process was in participants' indication that the stages were needed to demonstrate that they considered the costs and benefits of making a practice change. Participants indicated that EBTs endorsed by the Provincial Network for Eating Disorders or the Academy for Eating Disorders would more likely be adopted. DISCUSSION Future work should focus on integrating the important decision-making processes identified in this study with known implementation models to increase the use of low-cost and effective treatments, such as FBT, within eating disorder treatment programs.
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Affiliation(s)
- Melissa Kimber
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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11
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DeBate RD, Severson HH, Cragun DL, Gau JM, Merrell LK, Bleck JR, Christiansen S, Koerber A, Tomar SL, McCormack Brown KR, Tedesco LA, Hendricson W. Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors. HEALTH EDUCATION RESEARCH 2013; 28:472-487. [PMID: 23564725 PMCID: PMC3649212 DOI: 10.1093/her/cyt050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/21/2013] [Indexed: 06/02/2023]
Abstract
Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.
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Affiliation(s)
- Rita D DeBate
- Department of Community & Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
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McCormack J, Watson HJ, Harris C, Potts J, Forbes D. A hub and spokes approach to building community capacity for eating disorders in rural Western Australia. Aust J Rural Health 2013; 21:8-12. [PMID: 23384131 DOI: 10.1111/ajr.12007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether an outreach community-based training program on eating disorders enhances perceived capacity of rural health and education professionals to respond to and manage eating disorders. DESIGN Survey conducted upon completion of outreach training. SETTING Rural Western Australia. PARTICIPANTS Health and education professionals working in rural Western Australia. MAIN OUTCOME MEASURES Questionnaire responses analysed via descriptive statistics and inferential tests. RESULTS There was a significant increase in perceived ability to identify, support and/or treat people with eating disorders among health and education professionals. CONCLUSIONS Outreach training up-skilled rural gatekeepers and introduced systemic health system benefits of increased consultation and liaison, a fine-tuning of referral processes, a reduction in hospital admissions and better uptake of local services by patients discharged from hospital.
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Affiliation(s)
- Julie McCormack
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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Abstract
BACKGROUND Twenty years ago, Price published a survey identifying knowledge deficits of school counselors regarding eating disorders. Our study surveys current school counselors to determine whether knowledge has increased and determine the availability of school-based prevention programming. METHODS School counselors from a single metropolitan area were surveyed prior to a mandatory in-service on eating disorders. RESULTS Of the 109 respondents, 55% felt eating disorders were a problem in their school. Very few felt "very competent" identifying (6%) or helping (2%) students with eating disorders. Today's school counselors were more likely to know a symptom of anorexia nervosa (AN) is missing at least three consecutive menstrual cycles and malnutrition is not a common cause of death for bulimia nervosa (BN). CONCLUSIONS While knowledge of AN and BN appear to have increased, school counselors still lack some basic understanding and report very low confidence in identifying and helping students with eating disorders.
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Herschell AD, Kolko DJ, Baumann BL, Davis AC. The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev 2010; 30:448-66. [PMID: 20304542 PMCID: PMC2872187 DOI: 10.1016/j.cpr.2010.02.005] [Citation(s) in RCA: 416] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 02/18/2010] [Accepted: 02/23/2010] [Indexed: 12/28/2022]
Abstract
Evidence-based treatments (EBT) are underutilized in community settings, where consumers are often seen for treatment. Underutilization of EBTs may be related to a lack of empirically informed and supported training strategies. The goals of this review are to understand the state of the literature for training therapists in psychotherapy skills and to offer recommendations to improve research in this area. Results of this review of 55 studies evaluating six training methods indicate that multi-component trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, self-directed trainings, and workshops have documented that these methods do not routinely produce positive outcomes. Workshop follow-ups help to sustain outcomes. Little is known about the impact of train-the-trainer methods. Methodological flaws and factors that may influence training outcome and future directions are also reviewed.
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Affiliation(s)
- Amy D Herschell
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Beidas RS, Kendall PC. Training Therapists in Evidence-Based Practice: A Critical Review of Studies From a Systems-Contextual Perspective. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2010; 17:1-30. [PMID: 20877441 PMCID: PMC2945375 DOI: 10.1111/j.1468-2850.2009.01187.x] [Citation(s) in RCA: 515] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence-based practice (EBP), a preferred psychological treatment approach, requires training of community providers. The systems-contextual (SC) perspective, a model for dissemination and implementation efforts, underscores the importance of the therapist, client, and organizational variables that influence training and consequent therapist uptake and adoption of EBP. This review critiques the extant research on training in EBP from an SC perspective. Findings suggest that therapist knowledge improves and attitudinal change occurs following training. However, change in therapist behaviors (e.g., adherence, competence, and skill) and client outcomes only occurs when training interventions address each level of the SC model and include active learning. Limitations as well as areas for future research are discussed.
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Healthy Schools-Healthy Kids: a controlled evaluation of a comprehensive universal eating disorder prevention program. Body Image 2007; 4:115-36. [PMID: 18089258 DOI: 10.1016/j.bodyim.2007.01.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 12/14/2006] [Accepted: 01/06/2007] [Indexed: 11/23/2022]
Abstract
This study was a controlled evaluation of a comprehensive school-based universal prevention program involving male and female students, parents, teachers, school administrators and local public health professionals. A total of 982 male and female Grades 6 and 7 middle school students (and 91 teachers/school administrators) completed self-report surveys at baseline on measures of body satisfaction, internalization of media ideals, size acceptance, disordered eating, weight-based teasing, weight loss and muscle-gaining behaviours, and perceptions of school climate (teachers only). Eighty-four percent of the students repeated the surveys immediately following the 8-month school-wide intervention and 71% again 6 months later. Repeated measures ANCOVAs revealed that participation in the Healthy Schools-Healthy Kids (HS-HK) program had a positive influence by reducing the internalization of media ideals among male and female students and by reducing disordered eating among female students. The program was also associated with reductions in weight-loss behaviours among the students, although this effect was lost by the 6-month follow-up. When the intervention students were sub-divided into low versus high-risk groups, the high-risk group appeared to benefit most from the intervention with significant reductions in internalization of media ideals, greater body satisfaction, and reduced disordered eating over time. There were no intervention effects for teachers. Challenges of engaging teachers in prevention are discussed.
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