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Callaway CA, Sarfan LD, Agnew ER, Dong L, Spencer JM, Hache RE, Diaz M, Howlett SA, Fisher KR, Yates HEH, Stice E, Kilbourne AM, Buysse DJ, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial using train-the-trainer. Trials 2023; 24:503. [PMID: 37550730 PMCID: PMC10408147 DOI: 10.1186/s13063-023-07523-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes and (b) providers' perceptions of fit. METHODS TTT will be implemented in nine CMHCs in California, USA (N = 60 providers; N = 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality), and (3) evaluate other possible moderators. DISCUSSION This trial has potential to (a) inform the process of embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) add to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advance our understanding of providers' perceptions of EBPT "fit" across TTT generations. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05805657 . Registered on April 10, 2023.
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Affiliation(s)
| | | | | | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | | | | | | | | | | | | | | | - Amy M Kilbourne
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Callaway CA, Sarfan LD, Agnew ER, Dong L, Spencer JM, Hache RE, Diaz M, Howlett SA, Fisher KR, Yates HEH, Stice E, Kilbourne AM, Buysse DJ, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: Study protocol for a hybrid type 2 effectiveness-implementation cluster- randomized trial using train-the-trainer. RESEARCH SQUARE 2023:rs.3.rs-2943787. [PMID: 37398014 PMCID: PMC10312945 DOI: 10.21203/rs.3.rs-2943787/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes (b) providers' perceptions of fit. Methods TTT will be implemented in nine CMHCs in California, United States (N= 60 providers; N= 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will: (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality); and (3) evaluate other possible moderators. Discussion This trial has potential to inform the process of (a) embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) adding to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advancing our understanding of providers' perceptions of EBPT 'fit' across TTT generations. Trial registration Clinicaltrials.gov identifier: NCT05805657. Registered on April 10, 2023. https://clinicaltrials.gov/ct2/show/NCT05805657.
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Making Implementation Last: The Impact of Training Design on the Sustainability of an Evidence-Based Treatment in a Randomized Controlled Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:757-767. [PMID: 33728558 DOI: 10.1007/s10488-021-01126-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Although advances have been made in facilitating the implementation of evidence-based treatments, little is known about the most effective way to sustain their use over time. The current study examined the sustainability of one evidence-based treatment, Parent-Child Interaction Therapy (PCIT), following a statewide implementation trial testing three training methods: Cascading Model, Learning Collaborative, and Distance Education. Participants included 100 clinicians and 50 administrators from 50 organizations across Pennsylvania. Clinicians and administrators reported on sustainability at 24-months, as measured by the number of clients receiving PCIT and the continued use of the PCIT protocol. Multi-level path analysis was utilized to examine the role of training on sustainability. Clinicians and administrators reported high levels of sustainability at 24-months. Clinicians in the Cascading Model reported greater average PCIT caseloads at 24-months, whereas clinicians in the Learning Collaborative reported greater full use of the PCIT protocol at 24-months. Attending consultation calls was associated with delivering PCIT to fewer families. Implications for the sustainable delivery of PCIT beyond the training year as well as for the broader field of implementation science are discussed.
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Garcia D, Blizzard AM, Peskin A, Rothenberg WA, Schmidt E, Piscitello J, Espinosa N, Salem H, Rodriguez GM, Sherman JA, Parlade MV, Landa AL, Davis EM, Weinstein A, Garcia A, Perez C, Rivera JM, Martinez C, Jent JF. Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:269-283. [PMID: 33586056 PMCID: PMC7882248 DOI: 10.1007/s11121-021-01211-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent–Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (MChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.
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Affiliation(s)
- Dainelys Garcia
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA.
| | - Angela M Blizzard
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Abigail Peskin
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - W Andrew Rothenberg
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA.,Duke University Center for Child and Family Policy, Coral Gables, 33146, USA
| | - Ellyn Schmidt
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Jennifer Piscitello
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Natalie Espinosa
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Hanan Salem
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Gabriela M Rodriguez
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, 46202, USA
| | - Jamie A Sherman
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Meaghan V Parlade
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Alexis L Landa
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Eileen M Davis
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Allison Weinstein
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Angela Garcia
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Camille Perez
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Jessica M Rivera
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Chary Martinez
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Jason F Jent
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
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