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More Practice, Less Preach? The Role of Supervision Processes and Therapist Characteristics in EBP Implementation

  • Sarah Kate BearmanEmail author
  • John R. Weisz
  • Bruce F. Chorpita
  • Kimberly Hoagwood
  • Alyssa Ward
  • Ana M. Ugueto
  • Adam Bernstein
  • The Research Network on Youth Mental Health
Original Paper

Abstract

Identifying predictors of evidence-based practice (EBP) use, such as supervision processes and therapist characteristics, may support dissemination. Therapists (N = 57) received training and supervision in EBPs to treat community-based youth (N = 136). Supervision involving modeling and role-play predicted higher overall practice use than supervision involving discussion, and modeling predicted practice use in the next therapy session. No therapist characteristics predicted practice use, but therapist sex and age moderated the supervision and practice use relation. Supervision involving discussion predicted practice use for male therapists only, and modeling and role-play in supervision predicted practice use for older, not younger, therapists.

Keywords

Clinical supervision Therapist characteristics Treatment adherence Evidence based practices 

Notes

Funding

This study was supported by the John D. and Catherine T. MacArthur Foundation, The Norlien Foundation, and The National Institute of Mental Health. This manuscript was presented at the annual convention of the Association of Behavioral and Cognitive Therapies in November, 2011, Toronto, Canada.

References

  1. Aarons, G. (2004). Mental health provider attitudes toward adoption of evidence-based practice: the evidence-based practice attitude scale (EBPAS). Mental Health Services, 6, 61–74.CrossRefGoogle Scholar
  2. Accurso, E. C., Taylor, R. M., & Garland, A. F. (2011). Evidence-based practices addressed in community-based children’s mental health clinical supervision. Training and Education in Professional Psychology, 5, 88–96.CrossRefGoogle Scholar
  3. Aiken, L. S., & West, S. G. (1991). Multiple regression: testing and interpreting interactions. Newbury Park: Sage.Google Scholar
  4. American Psychological Association (2001). Policy statement on evidence-based practice in psychology. Available online at http://www2.apa.org/practice/ebpstatement.pdf. Accessed 29 Oct 2012.
  5. Ashcraft, R. P., Foster, S. L., Lowery, A. E., Henggeler, S. W., Chapman, J. E., & Rowland, M. D. (2011). Measuring practitioner attitudes toward evidence-based treatments: a validation study. Journal of Child & Adolescent Substance Abuse, 20, 166–183.CrossRefGoogle Scholar
  6. Baker, T. B., McFall, R. M., & Shoham, V. (2009). Current status and future prospects of clinical psychology: toward a scientifically principled approach to mental and behavioral health. Psychological Science in the Public Interest., 9, 4–144.Google Scholar
  7. Barkley, R. A. (1997). Defiant children: a clinician’s manual for assessment and parent training (2nd ed.). New York: Guilford.Google Scholar
  8. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 61, 1173–1182.CrossRefGoogle Scholar
  9. Baum, B. E., & Gray, J. J. (1992). Expert modeling, self-observation using videotape, and acquisition of basic therapy skills. Professional Psychology: Research and Practice, 23, 220–225.CrossRefGoogle Scholar
  10. Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17, 1–30.CrossRefGoogle Scholar
  11. Beidas, R. S., Koerner, K., Weingardt, K. R., & Kendall, P. C. (2011). Training research: practical recommendations for maximum impact. Administration and Policy in Mental Health and Mental Health Services Research, 38, 223–237.PubMedCrossRefGoogle Scholar
  12. Bennett-Levy, J., McManus, F., Westling, B. E., & Fennell, M. (2009). Acquiring and refining CBT skills and competencies: which training methods are perceived to be most effective? Behavioural and Cognitive Psychotherapy, 37, 571–583.PubMedCrossRefGoogle Scholar
  13. Beutler, L. E., Malik, M. L., Alimohamed, S., Harwood, T. M., Talebi, H., & Noble, S. (2004). Therapist variables. In M. J. Lambert, et al. (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 227–306). New York: Wiley.Google Scholar
  14. Bickman, L. (1999). Practice makes perfect and other myths about mental health services. American Psychologist, 54, 965–978.CrossRefGoogle Scholar
  15. Borders, L. D. (1990). Developmental changes during supervisees’ first practicum. Clinical Supervisor, 8, 157–167.CrossRefGoogle Scholar
  16. Brookman-Frazee, L., Garland, A. F., Taylor, R., & Zofness, R. (2009). Therapists' attitudes towards psychotherapeutic strategies in community-based psychotherapy with children with disruptive behavior problems. Administration and Policy in Mental Health and Mental Health Services Research, 36, 1–12. doi: 10.1007/s10488-008-0195-6.PubMedCrossRefGoogle Scholar
  17. Brookman-Frazee, L., Haine, R. A., Baker-Ericzen, M., Zoffness, R., & Garland, A. F. (2010). Factors associated with use of evidence-based practice strategies in usual care youth psychotherapy. Administration and Policy in Mental Health and Mental Health Services Research, 37, 254–269.PubMedCrossRefGoogle Scholar
  18. Cain, M., & Mittman, R. (2002). Diffusion of innovation in health care. California HealthCare Foundation. Available via California HealthCare Foundation. http://www.chcf.org/publications/2002/05/diffusion-of-innovation-in-health-care. Accessed 29 Feb 2013.
  19. Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., et al. (2011). Evidence-based treatments for children and adolescents: an updated review of indicators of efficacy and effectiveness. Evidence-based treatments for children and adolescents: an updated review of indicators of efficacy and effectiveness. Clinical Psychology: Science and Practice, 18, 154–172.CrossRefGoogle Scholar
  20. Chorpita, B. F., & Weisz, J. R. (2005). Modular approach to therapy for children with anxiety, depression, or conduct problems. Honolulu and Boston: University of Hawaii at Manoa and Judge Baker Children’s Center, Harvard Medical School.Google Scholar
  21. Cicchetii, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86, 127–137.Google Scholar
  22. Crits-Christoph, P., Siqueland, L., Chittams, J., Barber, J. P., Beck, A. T., Frank, A., et al. (1998). Training in cognitive, supportive-expressive, and drug counseling therapies for cocaine dependence. Journal of Consulting and Clinical Psychology, 66, 484–492.PubMedCrossRefGoogle Scholar
  23. Dimeff, L. A., Koerner, K., Woodcock, E. A., Beadnell, B., Brown, M. Z., Skutch, J. M., et al. (2009). Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills. Behavioural Research and Therapy, 47, 921–930.CrossRefGoogle Scholar
  24. Fairburn, C. G., & Cooper, Z. (2011). Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy, 49, 373–378.PubMedCrossRefGoogle Scholar
  25. Falender, C. A., Cornish, J., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal, G., et al. (2004). Defining Competencies in Psychology Supervision: a Consensus Statement. Journal of Clinical Psychology, 60, 771–785.PubMedCrossRefGoogle Scholar
  26. Garland, A. F., Brookman-Frazee, L., Hurlburt, M. S., Accurso, E. C., Zoffness, R. J., Haine-Schlagel, R., et al. (2010). Mental health care for children with disruptive behavior problems: a view inside therapists’ offices. Psychiatric Services, 61, 1–8.CrossRefGoogle Scholar
  27. Garland, A. F., Haine, R. A., & Boxmeyer, C. L. (2007). Determinates of youth and parent satisfaction in usual care psychotherapy. Evaluation and Program Planning, 30, 45–54.PubMedCrossRefGoogle Scholar
  28. Garland, A. F., Hurlburt, M. S., & Hawley, K. M. (2006). Examining psychotherapy processes in a services research context. Clinical Psychology: Science and Practice, 13, 30–46.CrossRefGoogle Scholar
  29. Glisson, C., Schoenwald, S. K., Kelleher, K., Landsverk, J., Hoagwood, K. E., Mayberg, S., et al. (2008). Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35, 124–133.PubMedCrossRefGoogle Scholar
  30. Henggeler, S. W., Schoenwald, S. K., Liao, J. G., Letourneau, E. J., & Edwards, D. L. (2002). Transporting efficacious treatments to field settings: the link between supervisory practices and therapist fidelity in MST programs. Journal of Clinical Child Psychology, 31, 155–167.Google Scholar
  31. Herschell, A. D., Kolko, D. J., Baumann, B. L., & David, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clinical Psychology Review, 30, 448–466.PubMedCrossRefGoogle Scholar
  32. Hoagwood, K., Burns, B. J., Kiser, L., Ringeisen, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52, 1179–1189.PubMedCrossRefGoogle Scholar
  33. Huppert, J. D., Bufka, L. F., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2001). Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder. Journal of Consulting and Clinical Psychology, 69, 747–755.PubMedCrossRefGoogle Scholar
  34. Hurlburt, M., Garland, A., Nguyen, K., & Brookman-Frazee, L. (2010). Child and family therapy process: concordance of therapist and observational perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 37, 230–244.PubMedCrossRefGoogle Scholar
  35. Kendall, P. C. (1994). Treating anxiety disorders in children: results of a randomized clinical trial. Journal of Consulting Clinical Psychology, 62, 100–110.PubMedCrossRefGoogle Scholar
  36. Kendall, P. C., Kane, M., Howard, B., & Siqueland, L. (1990). Cognitive-behavioral treatment of anxious children: treatment manual. Ardmore: Workbook.Google Scholar
  37. Kolb, D. A. (1984). Experiential learning. New Jersey: Prentice-Hall.Google Scholar
  38. Kolko, D. J., Cohen, J. A., Mannarino, A. P., Baumann, B. L., & Knudsen, K. (2009). Community treatment of child sexual abuse: a survey of practitioners in the National Child Traumatic Stress Network. Administration and Policy in Mental Health and Mental Health Services Research, 36, 37–49.PubMedCrossRefGoogle Scholar
  39. Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: barriers and facilitators of successful implementation. School Mental Health, 2, 105–113.PubMedCrossRefGoogle Scholar
  40. Michael, K. D., Huelsman, T. J., & Crowley, S. L. (2005). Interventions for child and adolescent depression: do professional therapists produce better results? Journal of Child and Family Studies, 14, 223–236.CrossRefGoogle Scholar
  41. Miller, W. R., & Mount, K. A. (2001). A small study of training in motivational interviewing: does one workshop change clinician and client behavior? Behavioural and Cognitive Psychotherapy, 29, 457–471.CrossRefGoogle Scholar
  42. Miller, W. R., Yahne, C. E., Moters, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 1050–1062.PubMedCrossRefGoogle Scholar
  43. Milne, D. L. (1982). A comparison of two methods of teaching behaviour modification to mental handicap nurses. Behavioural Psychotherapy, 10, 54–64.CrossRefGoogle Scholar
  44. Milne, D., Pilkington, J., Gracie, J., & James, I. (2003). Transferring skills from supervision to therapy: a qualitative and quantitative N = 1 analysis. Behavioural and Cognitive Psychotherapy, 31, 193–202.CrossRefGoogle Scholar
  45. Milne, D. L., Sheikh, A. I., Pattison, S., & Wilkinson, A. (2011). Evidence-based training for clinical supervisors: a systematic review of 11 controlled studies. The Clinical Supervisor, 30, 53–71.CrossRefGoogle Scholar
  46. Murray, M. M., Southerland, D., Farmer, E. M., & Ballentine, K. (2010). Enhancing and adapting treatment foster care: lessons learned in trying to change practice. Journal of Child and Family Studies, 19, 393–403.PubMedCrossRefGoogle Scholar
  47. Nakamura, B. J., Higa-McMillan, C. K., Okamura, K. H., & Shimabukuro, S. (2011). Knowledge of and attitudes towards evidence-based practices in community child mental health practitioners. Administration and Policy In Mental Health, 38, 287–300.PubMedCrossRefGoogle Scholar
  48. Nelson, T. D., & Steele, R. G. (2007). Predictors of practitioner self-reported use of evidence-based practices: practitioner training, clinical setting, and attitudes toward research. Administration and Policy in Mental Health and Mental Health Services Research, 34, 319–330.PubMedCrossRefGoogle Scholar
  49. Persons, J., & Silberschatz, G. (1998). Are results of randomized clinical trials useful to psychotherapists? Journal of Consulting and Clinical Psychology, 66, 126–135.PubMedCrossRefGoogle Scholar
  50. President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final Report (DHHS Pub. no. SMA-03-3832). Rockville: U.S. Department of Health and Human Services.Google Scholar
  51. Raudenbush, S., Bryk, A., Cheong, Y. F., & Congdon, R. (2004). HLM (Version 6.08) [Computer software]. Lincolnwood: Scientific Software International.Google Scholar
  52. Reinke, W. M., Stormont, M., Webster-Stratton, C., Newcomer, L. L., & Herman, K. C. (2012). The incredible years teacher classroom management program: using coaching to support generalization to real-world classroom settings. Psychology in the Schools, 49, 416–428.CrossRefGoogle Scholar
  53. Ruzek, J. I., & Rosen, R. C. (2009). Disseminating evidence-based treatments for PTSD in organizational settings: a high priority focus area. Behaviour Research and Therapy, 47, 980–989.PubMedCrossRefGoogle Scholar
  54. Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., & Southam Gerow, M. A. (2010). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38, 32–43.CrossRefGoogle Scholar
  55. Schoenwald, S. K., Garland, A. F., Southam-Gerow, M. A., Chorpita, B. F., & Chapman, J. E. (2011). Adherence measurement in treatments for disruptive behavior disorders: pursuing clear vision through varied lenses. Clinical Psychology: Science and Practice, 18, 331–341.CrossRefGoogle Scholar
  56. Schoenwald, S. K., Kelleher, K., Weisz, J., & The Research Network on Youth Mental Health. (2008). Building bridges to evidence-based practice: the MacArthur foundation child system and treatment enhancement projects (Child STEPs). Administration and Policy in Mental Health and Mental Health Services Research, 35, 66–72.PubMedCrossRefGoogle Scholar
  57. Schoenwald, S. K., Sheidow, A. J., & Chapman, J. E. (2009). Clinical supervision in treatment transport: effects on adherence and outcomes. Journal of Consulting and Clinical Psychology, 77, 410–421.PubMedCrossRefGoogle Scholar
  58. Schoenwald, S. K., Sheidow, A. J., & Letourneau, E. J. (2004). Toward effective quality assurance in evidence-based practice: links between expert consultation, therapist fidelity, and child outcomes. Journal of Clinical Child and Adolescent Psychology, 33, 94–104.PubMedCrossRefGoogle Scholar
  59. Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., & Nuro, K. F. (2005). We don’t train in vain: a dissemination trial of three strategies of training therapists in cognitive behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115.PubMedCrossRefGoogle Scholar
  60. Stewart, R. E., Chambless, D. L., & Baron, J. (2012). Theoretical and practical barriers to practitioners’ willingness to seek training in empirically supported treatments. Journal of Clinical Psychology, 68, 8–23.PubMedCrossRefGoogle Scholar
  61. U.S. Public Health Service, Office of the Surgeon General. (1999). Mental health: a report of the surgeon general. Rockville: U.S. Department of Health and Human Services.Google Scholar
  62. Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73, 914–923.PubMedCrossRefGoogle Scholar
  63. Ward, A. M., Regan, J., Chorpita, B. F., Starace, N., Rodriguez, A., Okamura, K., et al. (2013). Tracking evidence based practice with youth: Validity of the MATCH and Standard Manual Consultation Records. Journal of Clinical Child and Adolescent Psychology, 42, 44–55.Google Scholar
  64. Weisz, J. R. (2004). Psychotherapy for children and adolescents: evidence-based treatments and case examples. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  65. Weisz, J. R., & Addis, M. E. (2006). The research-practice tango and other choreographic challenges: Using and testing evidence-based psychotherapies in clinical care settings. In C. D. Goodheart, A. E. Kazdin, & R. J. Sternberg (Eds.), Evidence-based psychotherapy: where practice and research meet (pp. 179–206). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  66. Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S., et al. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Archives of General Psychiatry, 69, 274–282.PubMedCrossRefGoogle Scholar
  67. Weisz, J. R., Doss, A. J., & Hawley, K. M. (2005a). Youth psychotherapy outcome research: a review of critique of the evidence base. Annual Review of Psychology, 56, 337–363.PubMedCrossRefGoogle Scholar
  68. Weisz, J. R., & Gray, J. S. (2008). Evidence-based psychotherapy for children and adolescents: data from the present and a model for the future. Child and Adolescent Mental Health, 13, 54–65.CrossRefGoogle Scholar
  69. Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: a meta-analysis of direct comparisons. American Psychologist, 61, 671–689.PubMedCrossRefGoogle Scholar
  70. Weisz, J. R., Moore, P. S., Southam-Gerow, M. A., Weersing, V. R., Valeri, S. M., & McCarty, C. A. (2005b). Therapist’s Manual PASCET: primary and secondary control enhancement training program (3rd ed.). Los Angeles: University of California.Google Scholar
  71. Weisz, J. R., Thurber, C. A., Sweeney, L., Proffitt, V. D., & LeGagnoux, G. L. (1997). Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. Journal of Consulting Clinical Psychology, 65, 703–707.PubMedCrossRefGoogle Scholar
  72. Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counselors and therapists, their practice and their clients. A systematic review of the literature. Counseling and Psychotherapy Research, 7, 54–65.CrossRefGoogle Scholar
  73. Woo, S. M., Hepner, K. A., Gilbert, E. A., Osilla, K., Hunter, S. B., Muñoz, R. F., et al. (2012). Training addiction counselors to implement an evidence-based intervention: strategies for increasing organizational and provider acceptance. Cognitive and Behavioral Practice,. doi: 10.1016/j.cbpra.2012.03.004.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sarah Kate Bearman
    • 1
    Email author
  • John R. Weisz
    • 2
  • Bruce F. Chorpita
    • 3
  • Kimberly Hoagwood
    • 4
  • Alyssa Ward
    • 3
  • Ana M. Ugueto
    • 2
  • Adam Bernstein
    • 3
  • The Research Network on Youth Mental Health
  1. 1.Department of School-Clinical Child PsychologyFerkauf Graduate School of Psychology, Yeshiva UniversityBronxUSA
  2. 2.Department of Psychology, Harvard UniversityCambridgeUSA
  3. 3.Department of PsychologyUniversity of CaliforniaLos AngelesUSA
  4. 4.Department of Child and Adolescent Psychiatry, New York University School of MedicineNew YorkUSA

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