Abstract
Effective, interactive trainings in evidence-based practices remain expensive and largely inaccessible to most practicing clinicians. To address this need, the current study evaluated the impact of a low-cost, multi-component, web-based training for Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) on clinicians’ TF-CBT knowledge, strategy use, adherence and skill. Clinician members of a practice-based research network were recruited via email and randomized to either an immediate training group (N = 89 assigned) or waitlist control group (N = 74 assigned) that was offered access to the same training after six months, with half of each group further randomized to receive or not receive incentives for participation. Clinicians completed assessments at baseline, 6 months, and 12 months covering TF-CBT knowledge, strategy use, and for a subset of clinicians (n = 28), TF-CBT adherence and skill. Although significant differences in overall TF-CBT skillfulness and readiness were found, there were no significant differences between the training and waitlist control group on TF-CBT knowledge and strategy use at six months. However, there was considerable variability in the extent of training completed by clinicians. Subsequent post-hoc analyses indicated a significant, positive association between the extent of training completed by clinicians and clinician TF-CBT knowledge, strategy use, demonstrated adherence and skill across the three TF-CBT components, and overall TF-CBT readiness. We also explored whether incentives predicted training participation and found no differences in training activity participation between clinicians who were offered an incentive and those who were not. Findings highlight the limitations of self-paced web-based trainings. Implications for web-based trainings are discussed.
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24 March 2023
A Correction to this paper has been published: https://doi.org/10.1007/s10488-023-01265-y
Notes
Other aspects of this implementation study (i.e., qualitative interviews) and sample have previously been published (McMillen et al. 2016).
References
Barnett, M., Brookman-Frazee, L., Regan, J., Saifan, D., Stadnick, N., & Lau, A. (2017). How intervention and implementation characteristics relate to community therapists’ attitudes toward evidence-based practices: A mixed methods study. Administration and Policy in Mental Health and Mental Health Services Research, 44(6), 824–837. https://doi.org/10.1007/s10488-017-0795-0
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: A Publication of the Division of Clinical Psychology of the American Psychological Association, 17(1), 1–30. https://doi.org/10.1111/j.1468-2850.2009.01187.x
Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63(7), 660–665. https://doi.org/10.1176/appi.ps.201100401
Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K. E., Schoenwald, S., Evans, A. C., Hurford, M. O., Hadley, T., Barg, F. K., Walsh, L. M., Adams, D. R., & Mandell, D. S. (2015). Predictors of community therapists’ use of therapy techniques in a large public mental health system. JAMA Pediatrics, 169(4), 374–382. https://doi.org/10.1001/jamapediatrics.2014.3736.
Beidas, R. S., Becker-Haimes, E. M., Adams, D. R., Skriner, L., Stewart, R. E., Wolk, C. B., Buttenheim, A. M., Williams, N. J., Inacker, P., Richey, E., & Marcus, S. C. (2017). Feasibility and acceptability of incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: A pilot study to inform a randomized controlled trial. Implementation Science, 12(1), 148. https://doi.org/10.1186/s13012-017-0684-7
Borntrager, C., Chorpita, B. F., Higa-McMillan, C. K., Daleiden, E. L., & Starace, N. (2013). Usual care for trauma-exposed youth: Are clinician-reported therapy techniques evidence-based? Children and Youth Services Review, 35(1), 133–141. https://doi.org/10.1016/J.CHILDYOUTH.2012.09.018
Bryan, R. L., Kreuter, M. W., & Brownson, R. C. (2009). Integrating adult learning principles into training for public health practice. Health Promotion Practice, 10(4), 557–563. https://doi.org/10.1177/1524839907308117.
Cho, E., Wood, P. K., Taylor, E. K., Hausman, E. M., Andrews, J. H., & Hawley, K. M. (2019). Treatment strategies in youth mental health services: Results from a national survey of providers. Administration and Policy in Mental Health and Mental Health Services Research, 46(1), 71–81. https://doi.org/10.1007/s10488-018-0896-4
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. Guilford Press.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2016). Treating trauma and traumatic grief in children and adolescents (2nd ed.). Guilford Publications.
Cucciare, M. A., Weingardt, K. R., Villafranca, S., & Evaluation, C. (2008). Using blended learning to implement evidence-based. Health Care, 15, 299–307.
Dillman, D. (2000). Procedures for conducting government-sponsored establishment surveys: Comparisons of the total design method (TDM), a traditional cost-compensation. Proceedings of American Statistical Association, Second International Conference on Establishment Surveys, 343–352.
Frank, H. E., Becker-Haimes, E. M., & Kendall, P. C. (2020). Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. Clinical Psychology: Science and Practice. https://doi.org/10.1111/cpsp.12330
Friedberg, R. D. (2015). When treatment as usual gives you lemons, count on EVBPs: Economic arguments for training child clinicians in evidence-based practices. Child & Family Behavior Therapy, 37(4), 335–348. https://doi.org/10.1080/07317107.2015.1104782
Garland, A. F., Hurlburt, M. S., Brookman-Frazee, L., Taylor, R. M., & Accurso, E. C. (2010). Methodological challenges of characterizing usual care psychotherapeutic practice. Administration and Policy in Mental Health and Mental Health Services Research, 37(3), 2–18. https://doi.org/10.1007/s10488-009-0237-8.
Hawley, K. M., Cook, J. R., & Jensen-Doss, A. (2009). Do noncontingent incentives increase survey response rates among mental health providers? A randomized trial comparison. Administration and Policy in Mental Health and Mental Health Services Research, 36(5), 343–348. https://doi.org/10.1007/s10488-009-0225-z.
Heck, N. C., Saunders, B. E., & Smith, D. W. (2015). Web-based training for an evidence-supported treatment. Child Maltreatment, 20(3), 183–192. https://doi.org/10.1177/1077559515586569.
Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30(4), 448–466. https://doi.org/10.1016/j.cpr.2010.02.005
Herschell, A. D., Reed, A. J., Mecca, L. P., & Kolko, D. J. (2014). Community-based clinicians’ preferences for training in evidence-based practices: A mixed-method study. Professional Psychology: Research and Practice, 45(3), 188–199. https://doi.org/10.1037/a0036488
Hurlburt, M. S., Garland, A. F., 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(3), 230–244. https://doi.org/10.1007/s10488-009-0251-x
Jackson, C. B., Herschell, A. D., Schaffne, K. F., Turiano, N. A., & McNeil, C. B. (2017). Training community-based clinicians in parent-child interaction therapy: The interaction between expert consultation and caseload. Professional Psychology: Research and Practice, 48(6), 481–489. https://doi.org/10.1037/pro0000149
Jackson, C. B., Quetsch, L. B., Brabson, L. A., & Herschell, A. D. (2018). Web-based training methods for behavioral health providers: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 45(4), 587–610. https://doi.org/10.1007/s10488-018-0847-0
Liyanagunawardena, T. R., Adams, A. A., & Williams, S. A. (2013). MOOCs: A systematic study of the published literature 2008–2012. International Review of Research in Open and Distributed Learning, 14(3), 202–227.National Crime Victims Research & Treatment Center. (2007). TF-CBT Web: First Year Report. Medical University of South Carolina.
Marriott, B. M., Cho, E., Tugendrajch, S. K., Kliethermes, M. D., McMillen, J. C., Proctor, E. K., & Hawley, K. M. (2022). Role-play assessment of therapist adherence and skill in implementation of Trauma-Focused Cognitive-Behavioral Therapy. Administration and Policy in Mental Health and Mental Health Services Research, 49, 374–384. https://doi.org/10.1007/s10488-021-01169-9
McMillen, J. C., Hawley, K. M., & Proctor, E. K. (2016). Mental health clinicians’ participation in web-based training for an evidence supported intervention: Signs of encouragement and trouble ahead. Administration and Policy in Mental Health and Mental Health Services Research, 43, 592–603.
Powell, B. J., McMillen, J. C., Hawley, K. M., & Proctor, E. K. (2013). Mental health clinicians’ motivation to invest in training: results from a practice-based research network survey. Psychiatric Services, 64(8), 816–818. https://doi.org/10.1176/appi.ps.003602012.
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. A. E. (2015). A refined compilation of implementation strategies: Results from the expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), 1–14. https://doi.org/10.1186/s13012-015-0209-1
Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K. M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73(1), 106–115. https://doi.org/10.1037/0022-006X.73.1.106
Valentsein-Mah, H., Greer, N., McKenzie, L., Hansen, L., Strom, T. Q., Wiltsey Stirman, S., Wilt, T. J., & Kehle-Forbes, S. M. (2020). Effectivness of training methods for delivery of evidence-based psychotherapies: A systemic review. Implementation Science, 15, 40. https://doi.org/10.1186/s13012-020-00998-w
Acknowledgements
The authors would like to thank the anonymous reviewer for their suggestion to consider post-hoc correlations between the extent of training completed and clinician outcomes.
Funding
This research was supported by a grant from the Missouri Foundation for Health, the Center for Mental Health Services Research (P30 MH068579) and the Washington University Institute of Clinical and Translational Sciences (NIH/NCRR U54 RR024992).
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Missouri and Washington University in St. Louis Institutional Review Boards and with the1964 Helsinki Declaration and its later amendments or comparable ethical standards. Study procedures were approved by the Institutional Review Boards of University of Missouri and Washington University in St. Louis.
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Marriott, B.R., Kliethermes, M.D., McMillen, J.C. et al. Implementation of a Low-Cost, Multi-component, Web-Based Training for Trauma-Focused Cognitive-Behavioral Therapy. Adm Policy Ment Health 50, 392–399 (2023). https://doi.org/10.1007/s10488-022-01246-7
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DOI: https://doi.org/10.1007/s10488-022-01246-7