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 multicomponent trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, selfdirected 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. Keywords therapist training; implementation; dissemination; psychosocial treatmentsThe hope that mental health problems can be successfully ameliorated is supported by the availability of an increasing number of psychosocial treatment approaches with established efficacy (e.g., Silverman & Hinshaw, 2008). For example, efficacious treatment programs have been reported to address developmental disorders, behavioral and emotional disorders, substance abuse, eating disorders, personality disorders, and psychotic disorders, among others (e.g., Eyberg, Nelson, & Boggs, 2008;Scogin, Welsh, Hanson, Stump, & Coates, 2005). However, these approaches continue to be underutilized in community settings (Street, Niederehe, & Lebowitz, 2000) where millions of consumers receive mental health services Medicine, 3811 O'Hara Street -537 Bellefield Towers, Pittsburgh, PA 15213, 412-246-5897 (phone), 412-246-5341 (fax), HerschellAD@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Scope and Definitions of Evidence-Based TreatmentMore than 10 years ago, the American Psychological Associations' Division 12's (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures (1995) offered recommendations to promote efforts to define, study and evaluate, teach, and disseminate EBTs (then labeled empirically validated treatments and renamed empirically supported treatments; Chambless et al., 1998;Chambless et al., 1996). These recommendations included increasing the availability of empirically supported interventions, enforcing g...

Children with attention-deficit/hyperactivity disorder (ADHD) are at risk for adverse outcomes such as substance abuse and criminality, particularly if they develop conduct problems. Little is known about early predictors of the developmental course of conduct problems among children with ADHD, however. Parental psychopathology and parenting were assessed in 108 children who first met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ADHD at 4-7 years old. When demographic variables and baseline ADHD and conduct problems were controlled, maternal depression predicted conduct problems 2-8 years following the initial assessment, whereas positive parenting during the structured parent- child interaction task predicted fewer future conduct problems. These findings suggest that maternal depression is a risk factor, whereas early positive parenting is a protective factor, for the developmental course of conduct problems among children with ADHD.

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We investigated in 27 male Ironman triathletes aged 30.3 (9.1) years, with 77.7- (9.8) kg body mass, 1.78- (0.06) m body height, 24.3- (2.2) kg·m⁻² body mass index (BMI), and 14.4 (4.8) % body fat and in 16 female Ironman triathletes aged 36.6 (7.0) years, with 59.7- (6.1) kg body mass, 1.66- (0.06) m body height, 21.5 (1.0) kg·m⁻² BMI, and 22.8 (4.8) % body fat to ascertain whether anthropometric or training variables were related to total race time. The male athletes were training 14.8 (3.2) h·wk⁻¹ with a speed of 2.7 (0.6) km·h⁻¹ in swimming, 27.3 (3.0) in cycling, and 10.6 (1.4) in running. The female athletes trained for 13.9 (3.4) h·wk⁻¹ at 2.1 (0.8) km·h⁻¹h in swimming, 23.7 (7.6) km·h⁻¹ in cycling, and 9.0 (3.7) km·h⁻¹ in running, respectively. For male athletes, percent body fat was highly significantly (r² = 0.583; p < 0.001) associated with total race time. In female triathletes, training volume showed a relationship to total race time (r² = 0.466; p < 0.01). Percent body fat was unrelated to training volume for both men (r² = 0.001; p > 0.05) and women (r² = 0.007; p > 0.05). We conclude that percent body fat showed a relationship to total race time in male triathletes, and training volume showed an association with total race time in female triathletes. Presumably, the relationship between percent body fat, training volume, and race performance is genetically determined.

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The relationship of anthropometric and training characteristics with race time were investigated in 39 male and 24 female open-water ultra-endurance swimmers in a 26.4 km open-water ultra-swim, using bi-and multivariate analyses. For the men, body height, Body Mass Index, length of arm, and swimming speed during training were related to race time in the bivariate analysis. For the women, swimming speed during training was associated with performance in the bivariate analysis. In the multivariate analysis for the men, Body Mass Index and swimming speed during training were related to race time.

The Partnerships for Families project is a randomized clinical trial designed to evaluate the implementation of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT), an evidence-based treatment for family conflict, coercion, and aggression, including child physical abuse. To evaluate the effectiveness of a training program in this model, 182 community practitioners from 10 agencies were randomized to receive AF-CBT training (n = 90) using a learning community model (workshops, consultation visits) or Training as Usual (TAU; n = 92) which provided trainings per agency routine. Practitioners completed self-report measures at four time points (0, 6, 12, and 18 months following baseline). Of those assigned to AF-CBT, 89% participated in at least one training activity and 68% met a "training completion" definition. A total of 80 (44%) practitioners were still active clinicians in the study by 18-month assessment in that they had not met our staff turnover or study withdrawal criteria. Using an intent-to-train design, hierarchical linear modeling analyses revealed significantly greater initial improvements for those in the AF-CBT training condition (vs. TAU condition) in CBT-related knowledge and use of AF-CBT teaching processes, abuse-specific skills, and general psychological skills. In addition, practitioners in both groups reported significantly more negative perceptions of organizational climate through the intervention phase. These significant, albeit modest, findings are discussed in the context of treatment training, research, and work force issues as they relate to the diverse backgrounds, settings, and populations served by community practitioners.